hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number | IL,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
McDonough County Hospital District,3/25/2026,3.0.0,McDonough District Hospital|MDH Behavioral Health,525 E Grant Street Macomb IL 61455,1669420766|1437308475,140089,Sherri Hitchcock,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement,modifiers,standard_charge|gross,standard_charge|discounted_cash,standard_charge|min,standard_charge|max,additional_generic_notes,standard_charge|Aetna|Commercial|negotiated_dollar,standard_charge|Aetna|Commercial|negotiated_percentage,standard_charge|Aetna|Commercial|negotiated_algorithm,median_amount|Aetna|Commercial,10th_percentile|Aetna|Commercial,90th_percentile|Aetna|Commercial,count|Aetna|Commercial,standard_charge|Aetna|Commercial|methodology,additional_payer_notes|Aetna|Commercial,standard_charge|Aetna|Medicaid|negotiated_dollar,standard_charge|Aetna|Medicaid|negotiated_percentage,standard_charge|Aetna|Medicaid|negotiated_algorithm,median_amount|Aetna|Medicaid,10th_percentile|Aetna|Medicaid,90th_percentile|Aetna|Medicaid,count|Aetna|Medicaid,standard_charge|Aetna|Medicaid|methodology,additional_payer_notes|Aetna|Medicaid,standard_charge|Aetna|Medicare|negotiated_dollar,standard_charge|Aetna|Medicare|negotiated_percentage,standard_charge|Aetna|Medicare|negotiated_algorithm,median_amount|Aetna|Medicare,10th_percentile|Aetna|Medicare,90th_percentile|Aetna|Medicare,count|Aetna|Medicare,standard_charge|Aetna|Medicare|methodology,additional_payer_notes|Aetna|Medicare,standard_charge|Blue Choice|Commercial|negotiated_dollar,standard_charge|Blue Choice|Commercial|negotiated_percentage,standard_charge|Blue Choice|Commercial|negotiated_algorithm,median_amount|Blue Choice|Commercial,10th_percentile|Blue Choice|Commercial,90th_percentile|Blue Choice|Commercial,count|Blue Choice|Commercial,standard_charge|Blue Choice|Commercial|methodology,additional_payer_notes|Blue Choice|Commercial,standard_charge|Blue Cross Blue Shield|Commercial|negotiated_dollar,standard_charge|Blue Cross Blue Shield|Commercial|negotiated_percentage,standard_charge|Blue Cross Blue Shield|Commercial|negotiated_algorithm,median_amount|Blue Cross Blue Shield|Commercial,10th_percentile|Blue Cross Blue Shield|Commercial,90th_percentile|Blue Cross Blue Shield|Commercial,count|Blue Cross Blue Shield|Commercial,standard_charge|Blue Cross Blue Shield|Commercial|methodology,additional_payer_notes|Blue Cross Blue Shield|Commercial,standard_charge|Consociate|Commercial|negotiated_dollar,standard_charge|Consociate|Commercial|negotiated_percentage,standard_charge|Consociate|Commercial|negotiated_algorithm,median_amount|Consociate|Commercial,10th_percentile|Consociate|Commercial,90th_percentile|Consociate|Commercial,count|Consociate|Commercial,standard_charge|Consociate|Commercial|methodology,additional_payer_notes|Consociate|Commercial,standard_charge|Current Health|Commercial|negotiated_dollar,standard_charge|Current Health|Commercial|negotiated_percentage,standard_charge|Current Health|Commercial|negotiated_algorithm,median_amount|Current Health|Commercial,10th_percentile|Current Health|Commercial,90th_percentile|Current Health|Commercial,count|Current Health|Commercial,standard_charge|Current Health|Commercial|methodology,additional_payer_notes|Current Health|Commercial,standard_charge|HFN|Commercial|negotiated_dollar,standard_charge|HFN|Commercial|negotiated_percentage,standard_charge|HFN|Commercial|negotiated_algorithm,median_amount|HFN|Commercial,10th_percentile|HFN|Commercial,90th_percentile|HFN|Commercial,count|HFN|Commercial,standard_charge|HFN|Commercial|methodology,additional_payer_notes|HFN|Commercial,standard_charge|Health Alliance|Commercial|negotiated_dollar,standard_charge|Health Alliance|Commercial|negotiated_percentage,standard_charge|Health Alliance|Commercial|negotiated_algorithm,median_amount|Health Alliance|Commercial,10th_percentile|Health Alliance|Commercial,90th_percentile|Health Alliance|Commercial,count|Health Alliance|Commercial,standard_charge|Health Alliance|Commercial|methodology,additional_payer_notes|Health Alliance|Commercial,standard_charge|Health Alliance|Medicare|negotiated_dollar,standard_charge|Health Alliance|Medicare|negotiated_percentage,standard_charge|Health Alliance|Medicare|negotiated_algorithm,median_amount|Health Alliance|Medicare,10th_percentile|Health Alliance|Medicare,90th_percentile|Health Alliance|Medicare,count|Health Alliance|Medicare,standard_charge|Health Alliance|Medicare|methodology,additional_payer_notes|Health Alliance|Medicare,standard_charge|Healthlink|Commercial|negotiated_dollar,standard_charge|Healthlink|Commercial|negotiated_percentage,standard_charge|Healthlink|Commercial|negotiated_algorithm,median_amount|Healthlink|Commercial,10th_percentile|Healthlink|Commercial,90th_percentile|Healthlink|Commercial,count|Healthlink|Commercial,standard_charge|Healthlink|Commercial|methodology,additional_payer_notes|Healthlink|Commercial,standard_charge|Humana|Commercial|negotiated_dollar,standard_charge|Humana|Commercial|negotiated_percentage,standard_charge|Humana|Commercial|negotiated_algorithm,median_amount|Humana|Commercial,10th_percentile|Humana|Commercial,90th_percentile|Humana|Commercial,count|Humana|Commercial,standard_charge|Humana|Commercial|methodology,additional_payer_notes|Humana|Commercial,standard_charge|Humana|Medicare|negotiated_dollar,standard_charge|Humana|Medicare|negotiated_percentage,standard_charge|Humana|Medicare|negotiated_algorithm,median_amount|Humana|Medicare,10th_percentile|Humana|Medicare,90th_percentile|Humana|Medicare,count|Humana|Medicare,standard_charge|Humana|Medicare|methodology,additional_payer_notes|Humana|Medicare,standard_charge|Medicaid Aetna Better Health|Medicaid Aetna Better Health|negotiated_dollar,standard_charge|Medicaid Aetna Better Health|Medicaid Aetna Better Health|negotiated_percentage,standard_charge|Medicaid Aetna Better Health|Medicaid Aetna Better Health|negotiated_algorithm,median_amount|Medicaid Aetna Better Health|Medicaid Aetna Better Health,10th_percentile|Medicaid Aetna Better Health|Medicaid Aetna Better Health,90th_percentile|Medicaid Aetna Better Health|Medicaid Aetna Better Health,count|Medicaid Aetna Better Health|Medicaid Aetna Better Health,standard_charge|Medicaid Aetna Better Health|Medicaid Aetna Better Health|methodology,additional_payer_notes|Medicaid Aetna Better Health|Medicaid Aetna Better Health,standard_charge|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG|negotiated_dollar,standard_charge|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG|negotiated_percentage,standard_charge|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG|negotiated_algorithm,median_amount|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG,10th_percentile|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG,90th_percentile|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG,count|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG,standard_charge|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG|methodology,additional_payer_notes|Medicaid Blue Cross Community Family Health Plan XXL / XOG|Medicaid Blue Cross Community Family Health Plan XXL / XOG,standard_charge|Medicaid Countycare Claims|Medicaid Countycare Claims|negotiated_dollar,standard_charge|Medicaid Countycare Claims|Medicaid Countycare Claims|negotiated_percentage,standard_charge|Medicaid Countycare Claims|Medicaid Countycare Claims|negotiated_algorithm,median_amount|Medicaid Countycare Claims|Medicaid Countycare Claims,10th_percentile|Medicaid Countycare Claims|Medicaid Countycare Claims,90th_percentile|Medicaid Countycare Claims|Medicaid Countycare Claims,count|Medicaid Countycare Claims|Medicaid Countycare Claims,standard_charge|Medicaid Countycare Claims|Medicaid Countycare Claims|methodology,additional_payer_notes|Medicaid Countycare Claims|Medicaid Countycare Claims,standard_charge|Medicaid Health Alliance|Medicaid Health Alliance|negotiated_dollar,standard_charge|Medicaid Health Alliance|Medicaid Health Alliance|negotiated_percentage,standard_charge|Medicaid Health Alliance|Medicaid Health Alliance|negotiated_algorithm,median_amount|Medicaid Health Alliance|Medicaid Health Alliance,10th_percentile|Medicaid Health Alliance|Medicaid Health Alliance,90th_percentile|Medicaid Health Alliance|Medicaid Health Alliance,count|Medicaid Health Alliance|Medicaid Health Alliance,standard_charge|Medicaid Health Alliance|Medicaid Health Alliance|methodology,additional_payer_notes|Medicaid Health Alliance|Medicaid Health Alliance,standard_charge|Medicaid Humana Health Plan|Medicaid Humana Health Plan|negotiated_dollar,standard_charge|Medicaid Humana Health Plan|Medicaid Humana Health Plan|negotiated_percentage,standard_charge|Medicaid Humana Health Plan|Medicaid Humana Health Plan|negotiated_algorithm,median_amount|Medicaid Humana Health Plan|Medicaid Humana Health Plan,10th_percentile|Medicaid Humana Health Plan|Medicaid Humana Health Plan,90th_percentile|Medicaid Humana Health Plan|Medicaid Humana Health Plan,count|Medicaid Humana Health Plan|Medicaid Humana Health Plan,standard_charge|Medicaid Humana Health Plan|Medicaid Humana Health Plan|methodology,additional_payer_notes|Medicaid Humana Health Plan|Medicaid Humana Health Plan,standard_charge|Medicaid Illinois|Medicaid Illinois|negotiated_dollar,standard_charge|Medicaid Illinois|Medicaid Illinois|negotiated_percentage,standard_charge|Medicaid Illinois|Medicaid Illinois|negotiated_algorithm,median_amount|Medicaid Illinois|Medicaid Illinois,10th_percentile|Medicaid Illinois|Medicaid Illinois,90th_percentile|Medicaid Illinois|Medicaid Illinois,count|Medicaid Illinois|Medicaid Illinois,standard_charge|Medicaid Illinois|Medicaid Illinois|methodology,additional_payer_notes|Medicaid Illinois|Medicaid Illinois,standard_charge|Medicaid Meridian|Medicaid Meridian|negotiated_dollar,standard_charge|Medicaid Meridian|Medicaid Meridian|negotiated_percentage,standard_charge|Medicaid Meridian|Medicaid Meridian|negotiated_algorithm,median_amount|Medicaid Meridian|Medicaid Meridian,10th_percentile|Medicaid Meridian|Medicaid Meridian,90th_percentile|Medicaid Meridian|Medicaid Meridian,count|Medicaid Meridian|Medicaid Meridian,standard_charge|Medicaid Meridian|Medicaid Meridian|methodology,additional_payer_notes|Medicaid Meridian|Medicaid Meridian,standard_charge|Medicaid Molina|Medicaid Molina|negotiated_dollar,standard_charge|Medicaid Molina|Medicaid Molina|negotiated_percentage,standard_charge|Medicaid Molina|Medicaid Molina|negotiated_algorithm,median_amount|Medicaid Molina|Medicaid Molina,10th_percentile|Medicaid Molina|Medicaid Molina,90th_percentile|Medicaid Molina|Medicaid Molina,count|Medicaid Molina|Medicaid Molina,standard_charge|Medicaid Molina|Medicaid Molina|methodology,additional_payer_notes|Medicaid Molina|Medicaid Molina,standard_charge|Medicaid Wellcare|Medicaid Wellcare|negotiated_dollar,standard_charge|Medicaid Wellcare|Medicaid Wellcare|negotiated_percentage,standard_charge|Medicaid Wellcare|Medicaid Wellcare|negotiated_algorithm,median_amount|Medicaid Wellcare|Medicaid Wellcare,10th_percentile|Medicaid Wellcare|Medicaid Wellcare,90th_percentile|Medicaid Wellcare|Medicaid Wellcare,count|Medicaid Wellcare|Medicaid Wellcare,standard_charge|Medicaid Wellcare|Medicaid Wellcare|methodology,additional_payer_notes|Medicaid Wellcare|Medicaid Wellcare,standard_charge|Medicaid Youth Care|Medicaid Youth Care|negotiated_dollar,standard_charge|Medicaid Youth Care|Medicaid Youth Care|negotiated_percentage,standard_charge|Medicaid Youth Care|Medicaid Youth Care|negotiated_algorithm,median_amount|Medicaid Youth Care|Medicaid Youth Care,10th_percentile|Medicaid Youth Care|Medicaid Youth Care,90th_percentile|Medicaid Youth Care|Medicaid Youth Care,count|Medicaid Youth Care|Medicaid Youth Care,standard_charge|Medicaid Youth Care|Medicaid Youth Care|methodology,additional_payer_notes|Medicaid Youth Care|Medicaid Youth Care,standard_charge|Medicaid|Medicaid Illinois|negotiated_dollar,standard_charge|Medicaid|Medicaid Illinois|negotiated_percentage,standard_charge|Medicaid|Medicaid Illinois|negotiated_algorithm,median_amount|Medicaid|Medicaid Illinois,10th_percentile|Medicaid|Medicaid Illinois,90th_percentile|Medicaid|Medicaid Illinois,count|Medicaid|Medicaid Illinois,standard_charge|Medicaid|Medicaid Illinois|methodology,additional_payer_notes|Medicaid|Medicaid Illinois,standard_charge|Medicare|Medicare|negotiated_dollar,standard_charge|Medicare|Medicare|negotiated_percentage,standard_charge|Medicare|Medicare|negotiated_algorithm,median_amount|Medicare|Medicare,10th_percentile|Medicare|Medicare,90th_percentile|Medicare|Medicare,count|Medicare|Medicare,standard_charge|Medicare|Medicare|methodology,additional_payer_notes|Medicare|Medicare,standard_charge|Meridian|Medicaid Illinois|negotiated_dollar,standard_charge|Meridian|Medicaid Illinois|negotiated_percentage,standard_charge|Meridian|Medicaid Illinois|negotiated_algorithm,median_amount|Meridian|Medicaid Illinois,10th_percentile|Meridian|Medicaid Illinois,90th_percentile|Meridian|Medicaid Illinois,count|Meridian|Medicaid Illinois,standard_charge|Meridian|Medicaid Illinois|methodology,additional_payer_notes|Meridian|Medicaid Illinois,standard_charge|Molina|Medicaid Illinois|negotiated_dollar,standard_charge|Molina|Medicaid Illinois|negotiated_percentage,standard_charge|Molina|Medicaid Illinois|negotiated_algorithm,median_amount|Molina|Medicaid Illinois,10th_percentile|Molina|Medicaid Illinois,90th_percentile|Molina|Medicaid Illinois,count|Molina|Medicaid Illinois,standard_charge|Molina|Medicaid Illinois|methodology,additional_payer_notes|Molina|Medicaid Illinois,standard_charge|Mutual Medical|Commercial|negotiated_dollar,standard_charge|Mutual Medical|Commercial|negotiated_percentage,standard_charge|Mutual Medical|Commercial|negotiated_algorithm,median_amount|Mutual Medical|Commercial,10th_percentile|Mutual Medical|Commercial,90th_percentile|Mutual Medical|Commercial,count|Mutual Medical|Commercial,standard_charge|Mutual Medical|Commercial|methodology,additional_payer_notes|Mutual Medical|Commercial,standard_charge|Preferred Plan|Commercial|negotiated_dollar,standard_charge|Preferred Plan|Commercial|negotiated_percentage,standard_charge|Preferred Plan|Commercial|negotiated_algorithm,median_amount|Preferred Plan|Commercial,10th_percentile|Preferred Plan|Commercial,90th_percentile|Preferred Plan|Commercial,count|Preferred Plan|Commercial,standard_charge|Preferred Plan|Commercial|methodology,additional_payer_notes|Preferred Plan|Commercial,standard_charge|Springfield Health|Commercial|negotiated_dollar,standard_charge|Springfield Health|Commercial|negotiated_percentage,standard_charge|Springfield Health|Commercial|negotiated_algorithm,median_amount|Springfield Health|Commercial,10th_percentile|Springfield Health|Commercial,90th_percentile|Springfield Health|Commercial,count|Springfield Health|Commercial,standard_charge|Springfield Health|Commercial|methodology,additional_payer_notes|Springfield Health|Commercial,standard_charge|Tricare|Traditional|negotiated_dollar,standard_charge|Tricare|Traditional|negotiated_percentage,standard_charge|Tricare|Traditional|negotiated_algorithm,median_amount|Tricare|Traditional,10th_percentile|Tricare|Traditional,90th_percentile|Tricare|Traditional,count|Tricare|Traditional,standard_charge|Tricare|Traditional|methodology,additional_payer_notes|Tricare|Traditional,standard_charge|Trilogy|Commercial|negotiated_dollar,standard_charge|Trilogy|Commercial|negotiated_percentage,standard_charge|Trilogy|Commercial|negotiated_algorithm,median_amount|Trilogy|Commercial,10th_percentile|Trilogy|Commercial,90th_percentile|Trilogy|Commercial,count|Trilogy|Commercial,standard_charge|Trilogy|Commercial|methodology,additional_payer_notes|Trilogy|Commercial,standard_charge|United Healthcare Current|Commercial|negotiated_dollar,standard_charge|United Healthcare Current|Commercial|negotiated_percentage,standard_charge|United Healthcare Current|Commercial|negotiated_algorithm,median_amount|United Healthcare Current|Commercial,10th_percentile|United Healthcare Current|Commercial,90th_percentile|United Healthcare Current|Commercial,count|United Healthcare Current|Commercial,standard_charge|United Healthcare Current|Commercial|methodology,additional_payer_notes|United Healthcare Current|Commercial,standard_charge|United Healthcare|Commercial|negotiated_dollar,standard_charge|United Healthcare|Commercial|negotiated_percentage,standard_charge|United Healthcare|Commercial|negotiated_algorithm,median_amount|United Healthcare|Commercial,10th_percentile|United Healthcare|Commercial,90th_percentile|United Healthcare|Commercial,count|United Healthcare|Commercial,standard_charge|United Healthcare|Commercial|methodology,additional_payer_notes|United Healthcare|Commercial,standard_charge|United Healthcare|Medicare|negotiated_dollar,standard_charge|United Healthcare|Medicare|negotiated_percentage,standard_charge|United Healthcare|Medicare|negotiated_algorithm,median_amount|United Healthcare|Medicare,10th_percentile|United Healthcare|Medicare,90th_percentile|United Healthcare|Medicare,count|United Healthcare|Medicare,standard_charge|United Healthcare|Medicare|methodology,additional_payer_notes|United Healthcare|Medicare,standard_charge|Veteran Affairs|Traditional|negotiated_dollar,standard_charge|Veteran Affairs|Traditional|negotiated_percentage,standard_charge|Veteran Affairs|Traditional|negotiated_algorithm,median_amount|Veteran Affairs|Traditional,10th_percentile|Veteran Affairs|Traditional,90th_percentile|Veteran Affairs|Traditional,count|Veteran Affairs|Traditional,standard_charge|Veteran Affairs|Traditional|methodology,additional_payer_notes|Veteran Affairs|Traditional
ICU Nurse,3906,CDM,,,0200,RC,,,facility,inpatient,,,,55,33,45.1,55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",46.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",49.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",49.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,49.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",49.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,52.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",45.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,46.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,49.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: Nursery Level I,1006,CDM,,,0171,RC,,,facility,inpatient,,,,1409,845.4,1155.38,1409,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1409,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1197.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1268.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1268.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1268.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1268.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1338.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1155.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1197.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1268.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: Senior Behavioral Health,1030,CDM,,,0114,RC,,,facility,inpatient,,,,1565,939,1283.3,1565,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1565,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1330.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1408.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1408.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1408.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1408.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1486.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1283.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1330.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1408.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: Nursery Level II,1009,CDM,,,0172,RC,,,facility,inpatient,,,,1942,1165.2,1592.44,1942,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1942,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1650.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1844.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1592.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1650.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: Med/Surg,1025,CDM,,,0120,RC,,,facility,inpatient,,,,1942,1165.2,1592.44,1942,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1942,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1650.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1844.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1592.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1650.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: Swing Bed,1040,CDM,,,0120,RC,,,facility,inpatient,,,,1942,1165.2,1592.44,1942,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1942,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1650.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1747.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1844.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1592.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1650.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1747.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: Nursery Level III,1010,CDM,,,0173,RC,,,facility,inpatient,,,,2556,1533.6,2095.92,2556,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2556,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2172.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2300.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2300.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2300.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2300.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2428.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2095.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2172.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2300.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: Labor/Delivery,1005,CDM,,,0122,RC,,,facility,inpatient,,,,3109,1865.4,2549.38,3109,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3109,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2642.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2798.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2798.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2798.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2798.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2953.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2549.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2642.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2798.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ROOM/BED: ICU,1001,CDM,,,0200,RC,,,facility,inpatient,,,,4432,2659.2,3634.24,4432,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4432,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3767.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3988.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3988.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3988.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3988.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4210.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3634.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3767.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3988.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Swallow Current Status G-8996,38800,CDM,G8996,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Swallow Current Status G-8996,38801,CDM,G8996,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Swallow Current Status G-8996,38802,CDM,G8996,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Swallow Current Status G-8996,38803,CDM,G8996,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Swallow Current Status G-8996,38804,CDM,G8996,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Swallow Current Status G-8996,38805,CDM,G8996,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Swallow Current Status G-8996,38806,CDM,G8996,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Swallow Goal Status G-8997,38807,CDM,G8997,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Swallow Goal Status G-8997,38808,CDM,G8997,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Swallow Goal Status G-8997,38810,CDM,G8997,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Swallow Goal Status G-8997,38811,CDM,G8997,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Swallow Goal Status G-8997,38812,CDM,G8997,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Swallow Goal Status G-8997,38813,CDM,G8997,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Swallow Discharge Status G-8998,38814,CDM,G8998,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Swallow Discharge Status G-8998,38815,CDM,G8998,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Swallow Discharge Status G-8998,38816,CDM,G8998,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Swallow Discharge Status G-8998,38817,CDM,G8998,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Swallow Discharge Status G-8998,38818,CDM,G8998,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Swallow Discharge Status G-8998,38819,CDM,G8998,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Swallow Discharge Status G-8998,38820,CDM,G8998,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Motor Speech Current Status G-8999,38821,CDM,G8999,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Motor Speech Current Status G-8999,38822,CDM,G8999,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Motor Speech Current Status G-8999,38823,CDM,G8999,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Motor Speech Current Status G-8999,38824,CDM,G8999,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Motor Speech Current Status G-8999,38825,CDM,G8999,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Motor Speech Current Status G-8999,38826,CDM,G8999,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Motor Speech Current Status G-8999,38827,CDM,G8999,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Motor Speech Goal Status G-9186,38828,CDM,G9186,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Motor Speech Goal Status G-9186,38829,CDM,G9186,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Motor Speech Goal Status G-9186,38830,CDM,G9186,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Motor Speech Goal Status G-9186,38831,CDM,G9186,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Motor Speech Goal Status G-9186,38832,CDM,G9186,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Motor Speech Goal Status G-9186,38833,CDM,G9186,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Motor Speech Goal Status G-9186,38834,CDM,G9186,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Motor Speech Discharge Status G-9158,38835,CDM,G9158,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Motor Speech Discharge Status G-9158,38836,CDM,G9158,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Motor Speech Discharge Status G-9158,38837,CDM,G9158,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Motor Speech Discharge Status G-9158,38838,CDM,G9158,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Motor Speech Discharge Status G-9158,38839,CDM,G9158,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Motor Speech Discharge Status G-9158,38840,CDM,G9158,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Motor Speech Discharge Status G-9158,38841,CDM,G9158,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Spoken Lang Comprehension Current G-9159,38842,CDM,G9159,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Spoken Lang Comprehension Current G-9159,38843,CDM,G9159,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Spoken Lang Comprehension Current G-9159,38844,CDM,G9159,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Spoken Lang Comprehension Current G-9159,38845,CDM,G9159,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Spoken Lang Comprehension Current G-9159,38846,CDM,G9159,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Spoken Lang Comprehension Current G-9159,38847,CDM,G9159,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Spoken Lang Comprehension Current G-9159,38848,CDM,G9159,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Spoken Lang Comprehension Goal G-9160,38849,CDM,G9160,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Spoken Lang Comprehension Goal G-9160,38850,CDM,G9160,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Spoken Lang Comprehension Goal G-9160,38851,CDM,G9160,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Spoken Lang Comprehension Goal G-9160,38852,CDM,G9160,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Spoken Lang Comprehension Goal G-9160,38853,CDM,G9160,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Spoken Lang Comprehension Goal G-9160,38854,CDM,G9160,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Spoken Lang Comprehension Goal G-9160,38855,CDM,G9160,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Spoken Lang Comprehension DC G-9161,38856,CDM,G9161,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Spoken Lang Comprehension DC G-9161,38857,CDM,G9161,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Spoken Lang Comprehension DC G-9161,38858,CDM,G9161,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Spoken Lang Comprehension DC G-9161,38859,CDM,G9161,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Spoken Lang Comprehension DC G-9161,38860,CDM,G9161,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Spoken Lang Comprehension DC G-9161,38861,CDM,G9161,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Spoken Lang Comprehension DC G-9161,38862,CDM,G9161,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Spoken Lang Expression Current G-9162,38863,CDM,G9162,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Spoken Lang Expression Current G-9162,38864,CDM,G9162,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Spoken Lang Expression Current G-9162,38865,CDM,G9162,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Spoken Lang Expression Current G-9162,38866,CDM,G9162,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Spoken Lang Expression Current G-9162,38867,CDM,G9162,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Spoken Lang Expression Current G-9162,38868,CDM,G9162,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Spoken Lang Expression Current G-9162,38869,CDM,G9162,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Spoken Language Expression Goal G-9163,38870,CDM,G9163,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Spoken Language Expression Goal G-9163,38871,CDM,G9163,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Spoken Language Expression Goal G-9163,38872,CDM,G9163,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Spoken Language Expression Goal G-9163,38873,CDM,G9163,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Spoken Language Expression Goal G-9163,38874,CDM,G9163,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Spoken Language Expression Goal G-9163,38875,CDM,G9163,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Spoken Language Expression Goal G-9163,38876,CDM,G9163,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Spoken Lang Expression DC Status G-9164,38877,CDM,G9164,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Spoken Lang Expression DC Status G-9164,38878,CDM,G9164,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Spoken Lang Expression DC Status G-9164,38879,CDM,G9164,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Spoken Lang Expression DC Status G-9164,38880,CDM,G9164,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Spoken Lang Expression DC Status G-9164,38881,CDM,G9164,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Spoken Lang Expression DC Status G-9164,38882,CDM,G9164,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Spoken Lang Expression DC Status G-9164,38883,CDM,G9164,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Attention Current Status G-9165,38884,CDM,G9165,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Attention Current Status G-9165,38885,CDM,G9165,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Attention Current Status G-9165,38886,CDM,G9165,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Attention Current Status G-9165,38887,CDM,G9165,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Attention Current Status G-9165,38888,CDM,G9165,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Attention Current Status G-9165,38889,CDM,G9165,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Attention Current Status G-9165,38890,CDM,G9165,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Attention Goal Status G-9166,38891,CDM,G9166,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Attention Goal Status G-9166,38892,CDM,G9166,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Attention Goal Status G-9166,38893,CDM,G9166,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Attention Goal Status G-9166,38894,CDM,G9166,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Attention Goal Status G-9166,38895,CDM,G9166,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Attention Goal Status G-9166,38896,CDM,G9166,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Attention Goal Status G-9166,38897,CDM,G9166,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Attention Discharge Status G-9167,38898,CDM,G9167,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Attention Discharge Status G-9167,38899,CDM,G9167,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Attention Discharge Status G-9167,38900,CDM,G9167,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Attention Discharge Status G-9167,38901,CDM,G9167,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Attention Discharge Status G-9167,38902,CDM,G9167,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Attention Discharge Status G-9167,38903,CDM,G9167,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Attention Discharge Status G-9167,38904,CDM,G9167,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Memory Current Status G-9168,38905,CDM,G9168,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Memory Current Status G-9168,38906,CDM,G9168,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Memory Current Status G-9168,38907,CDM,G9168,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Memory Current Status G-9168,38908,CDM,G9168,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Memory Current Status G-9168,38909,CDM,G9168,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Memory Current Status G-9168,38910,CDM,G9168,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Memory Current Status G-9168,38911,CDM,G9168,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Memory Goal Status G-9169,38912,CDM,G9169,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Memory Goal Status G-9169,38913,CDM,G9169,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Memory Goal Status G-9169,38914,CDM,G9169,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Memory Goal Status G-9169,38915,CDM,G9169,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Memory Goal Status G-9169,38916,CDM,G9169,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Memory Goal Status G-9169,38917,CDM,G9169,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Memory Goal Status G-9169,38918,CDM,G9169,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Memory Discharge Status G-9170,38919,CDM,G9170,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Memory Discharge Status G-9170,38920,CDM,G9170,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Memory Discharge Status G-9170,38921,CDM,G9170,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Memory Discharge Status G-9170,38922,CDM,G9170,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Memory Discharge Status G-9170,38923,CDM,G9170,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Memory Discharge Status G-9170,38924,CDM,G9170,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Memory Discharge Status G-9170,38925,CDM,G9170,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Voice Current Status G-9171,38926,CDM,G9171,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Voice Current Status G-9171,38927,CDM,G9171,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Voice Current Status G-9171,38928,CDM,G9171,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Voice Current Status G-9171,38929,CDM,G9171,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Voice Current Status G-9171,38930,CDM,G9171,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Voice Current Status G-9171,38931,CDM,G9171,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Voice Current Status G-9171,38932,CDM,G9171,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Voice Goal Status G-9172,38933,CDM,G9172,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Voice Goal Status G-9172,38934,CDM,G9172,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Voice Goal Status G-9172,38935,CDM,G9172,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Voice Goal Status G-9172,38936,CDM,G9172,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Voice Goal Status G-9172,38937,CDM,G9172,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Voice Goal Status G-9172,38938,CDM,G9172,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Voice Goal Status G-9172,38939,CDM,G9172,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Voice Discharge Status G-9173,38940,CDM,G9173,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Voice Discharge Status G-9173,38941,CDM,G9173,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Voice Discharge Status G-9173,38942,CDM,G9173,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Voice Discharge Status G-9173,38943,CDM,G9173,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Voice Discharge Status G-9173,38944,CDM,G9173,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Voice Discharge Status G-9173,38945,CDM,G9173,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Voice Discharge Status G-9173,38946,CDM,G9173,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Other SLP Current Status G-9174,38947,CDM,G9174,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Other SLP Current Status G-9174,38948,CDM,G9174,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Other SLP Current Status G-9174,38949,CDM,G9174,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Other SLP Current Status G-9174,38950,CDM,G9174,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Other SLP Current Status G-9174,38951,CDM,G9174,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Other SLP Current Status G-9174,38952,CDM,G9174,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Other SLP Current Status G-9174,38953,CDM,G9174,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Other SLP Goal Status G-9175,38954,CDM,G9175,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Other SLP Goal Status G-9175,38955,CDM,G9175,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Other SLP Goal Status G-9175,38956,CDM,G9175,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Other SLP Goal Status G-9175,38957,CDM,G9175,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Other SLP Goal Status G-9175,38958,CDM,G9175,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Other SLP Goal Status G-9175,38959,CDM,G9175,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Other SLP Goal Status G-9175,38960,CDM,G9175,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - Other SLP Discharge Status G-9176,38961,CDM,G9176,CPT,0440,RC,,,facility,inpatient,,,GN|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - Other SLP Discharge Status G-9176,38962,CDM,G9176,CPT,0440,RC,,,facility,inpatient,,,GN|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - Other SLP Discharge Status G-9176,38963,CDM,G9176,CPT,0440,RC,,,facility,inpatient,,,GN|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - Other SLP Discharge Status G-9176,38964,CDM,G9176,CPT,0440,RC,,,facility,inpatient,,,GN|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - Other SLP Discharge Status G-9176,38965,CDM,G9176,CPT,0440,RC,,,facility,inpatient,,,GN|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - Other SLP Discharge Status G-9176,38966,CDM,G9176,CPT,0440,RC,,,facility,inpatient,,,GN|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - Other SLP Discharge Status G-9176,38967,CDM,G9176,CPT,0440,RC,,,facility,inpatient,,,GN|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Mobility Current Status G-8978,50650,CDM,G8978,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Mobility Current Status G-8978,50651,CDM,G8978,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Mobility Current Status G-8978,50652,CDM,G8978,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Mobility Current Status G-8978,50653,CDM,G8978,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Mobility Current Status G-8978,50654,CDM,G8978,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Mobility Current Status G-8978,50655,CDM,G8978,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Mobility Current Status G-8978,50656,CDM,G8978,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Mobility Goal Status G-8979,50657,CDM,G8979,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Mobility Goal Status G-8979,50658,CDM,G8979,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Mobility Goal Status G-8979,50660,CDM,G8979,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Mobility Goal Status G-8979,50661,CDM,G8979,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Mobility Goal Status G-8979,50662,CDM,G8979,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Mobility Goal Status G-8979,50663,CDM,G8979,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Mobility Discharge Status G-8980,50664,CDM,G8980,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Mobility Discharge Status G-8980,50665,CDM,G8980,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Mobility Discharge Status G-8980,50666,CDM,G8980,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Mobility Discharge Status G-8980,50667,CDM,G8980,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Mobility Discharge Status G-8980,50668,CDM,G8980,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Mobility Discharge Status G-8980,50669,CDM,G8980,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Mobility Discharge Status G-8980,50670,CDM,G8980,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Body Position Current Status G-8981,50671,CDM,G8981,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Body Position Current Status G-8981,50672,CDM,G8981,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Body Position Current Status G-8981,50673,CDM,G8981,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Body Position Current Status G-8981,50674,CDM,G8981,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Body Position Current Status G-8981,50675,CDM,G8981,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Body Position Current Status G-8981,50676,CDM,G8981,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Body Position Current Status G-8981,50677,CDM,G8981,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Body Position Goal Status G-8982,50678,CDM,G8982,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Body Position Goal Status G-8982,50679,CDM,G8982,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Body Position Goal Status G-8982,50680,CDM,G8982,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Body Position Goal Status G-8982,50681,CDM,G8982,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Body Position Goal Status G-8982,50682,CDM,G8982,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Body Position Goal Status G-8982,50683,CDM,G8982,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Body Position Goal Status G-8982,50684,CDM,G8982,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Body Position DC Status G-8983,50685,CDM,G8983,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Body Position DC Status G-8983,50686,CDM,G8983,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Body Position DC Status G-8983,50687,CDM,G8983,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Body Position DC Status G-8983,50688,CDM,G8983,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Body Position DC Status G-8983,50689,CDM,G8983,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Body Position DC Status G-8983,50690,CDM,G8983,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Body Position DC Status G-8983,50691,CDM,G8983,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Carry Current Status G-8984,50692,CDM,G8984,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Carry Current Status G-8984,50693,CDM,G8984,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Carry Current Status G-8984,50694,CDM,G8984,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Carry Current Status G-8984,50695,CDM,G8984,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Carry Current Status G-8984,50696,CDM,G8984,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Carry Current Status G-8984,50697,CDM,G8984,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Carry Current Status G-8984,50698,CDM,G8984,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Carry Goal Status G-8985,50699,CDM,G8985,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Carry Goal Status G-8985,50700,CDM,G8985,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Carry Goal Status G-8985,50701,CDM,G8985,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Carry Goal Status G-8985,50702,CDM,G8985,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Carry Goal Status G-8985,50703,CDM,G8985,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Carry Goal Status G-8985,50704,CDM,G8985,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Carry Goal Status G-8985,50705,CDM,G8985,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Carry Discharge Status G-8986,50706,CDM,G8986,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Carry Discharge Status G-8986,50707,CDM,G8986,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Carry Discharge Status G-8986,50708,CDM,G8986,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Carry Discharge Status G-8986,50709,CDM,G8986,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Carry Discharge Status G-8986,50710,CDM,G8986,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Carry Discharge Status G-8986,50711,CDM,G8986,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Carry Discharge Status G-8986,50712,CDM,G8986,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Self-Care Current Status G-8987,50713,CDM,G8987,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Self-Care Current Status G-8987,50714,CDM,G8987,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Self-Care Current Status G-8987,50715,CDM,G8987,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Self-Care Current Status G-8987,50716,CDM,G8987,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Self-Care Current Status G-8987,50717,CDM,G8987,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Self-Care Current Status G-8987,50718,CDM,G8987,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Self-Care Current Status G-8987,50719,CDM,G8987,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Self-Care Goal Status G-8988,50720,CDM,G8988,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Self-Care Goal Status G-8988,50721,CDM,G8988,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Self-Care Goal Status G-8988,50722,CDM,G8988,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Self-Care Goal Status G-8988,50723,CDM,G8988,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Self-Care Goal Status G-8988,50724,CDM,G8988,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Self-Care Goal Status G-8988,50725,CDM,G8988,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Self-Care Goal Status G-8988,50726,CDM,G8988,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Self-Care Discharge Status G-8989,50727,CDM,G8989,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Self-Care Discharge Status G-8989,50728,CDM,G8989,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Self-Care Discharge Status G-8989,50729,CDM,G8989,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Self-Care Discharge Status G-8989,50730,CDM,G8989,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Self-Care Discharge Status G-8989,50731,CDM,G8989,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Self-Care Discharge Status G-8989,50732,CDM,G8989,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Self-Care Discharge Status G-8989,50733,CDM,G8989,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Other Primary Current Status G-8990,50734,CDM,G8990,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Other Primary Current Status G-8990,50735,CDM,G8990,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Other Primary Current Status G-8990,50736,CDM,G8990,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Other Primary Current Status G-8990,50737,CDM,G8990,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Other Primary Current Status G-8990,50738,CDM,G8990,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Other Primary Current Status G-8990,50739,CDM,G8990,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Other Primary Current Status G-8990,50740,CDM,G8990,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Other Primary Goal Status G-8991,50741,CDM,G8991,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Other Primary Goal Status G-8991,50742,CDM,G8991,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Other Primary Goal Status G-8991,50743,CDM,G8991,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Other Primary Goal Status G-8991,50744,CDM,G8991,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Other Primary Goal Status G-8991,50745,CDM,G8991,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Other Primary Goal Status G-8991,50746,CDM,G8991,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Other Primary Goal Status G-8991,50747,CDM,G8991,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Other Primary Discharge Status G-8992,50748,CDM,G8992,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Other Primary Discharge Status G-8992,50749,CDM,G8992,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Other Primary Discharge Status G-8992,50750,CDM,G8992,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Other Primary Discharge Status G-8992,50751,CDM,G8992,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Other Primary Discharge Status G-8992,50752,CDM,G8992,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Other Primary Discharge Status G-8992,50753,CDM,G8992,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Other Primary Discharge Status G-8992,50754,CDM,G8992,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Subsequent Current Status G-8993,50755,CDM,G8993,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Subsequent Current Status G-8993,50756,CDM,G8993,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Subsequent Current Status G-8993,50757,CDM,G8993,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Subsequent Current Status G-8993,50758,CDM,G8993,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Subsequent Current Status G-8993,50759,CDM,G8993,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Subsequent Current Status G-8993,50760,CDM,G8993,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Subsequent Current Status G-8993,50761,CDM,G8993,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Subsequent Goal Status G-8994,50762,CDM,G8994,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Subsequent Goal Status G-8994,50763,CDM,G8994,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Subsequent Goal Status G-8994,50764,CDM,G8994,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Subsequent Goal Status G-8994,50765,CDM,G8994,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Subsequent Goal Status G-8994,50766,CDM,G8994,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Subsequent Goal Status G-8994,50767,CDM,G8994,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Subsequent Goal Status G-8994,50768,CDM,G8994,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - PT Subsequent DC Status G-8995,50769,CDM,G8995,CPT,0420,RC,,,facility,inpatient,,,GP|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - PT Subsequent DC Status G-8995,50770,CDM,G8995,CPT,0420,RC,,,facility,inpatient,,,GP|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - PT Subsequent DC Status G-8995,50771,CDM,G8995,CPT,0420,RC,,,facility,inpatient,,,GP|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - PT Subsequent DC Status G-8995,50772,CDM,G8995,CPT,0420,RC,,,facility,inpatient,,,GP|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - PT Subsequent DC Status G-8995,50773,CDM,G8995,CPT,0420,RC,,,facility,inpatient,,,GP|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - PT Subsequent DC Status G-8995,50774,CDM,G8995,CPT,0420,RC,,,facility,inpatient,,,GP|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - PT Subsequent DC Status G-8995,50775,CDM,G8995,CPT,0420,RC,,,facility,inpatient,,,GP|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Mobility Current Status G-8978,53284,CDM,G8978,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Mobility Current Status G-8978,53285,CDM,G8978,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Mobility Current Status G-8978,53286,CDM,G8978,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Mobility Current Status G-8978,53287,CDM,G8978,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Mobility Current Status G-8978,53288,CDM,G8978,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Mobility Current Status G-8978,53289,CDM,G8978,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Mobility Current Status G-8978,53290,CDM,G8978,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Mobility Goal Status G-8979,53291,CDM,G8979,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Mobility Goal Status G-8979,53292,CDM,G8979,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Mobility Goal Status G-8979,53293,CDM,G8979,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Mobility Goal Status G-8979,53294,CDM,G8979,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Mobility Goal Status G-8979,53295,CDM,G8979,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Mobility Goal Status G-8979,53296,CDM,G8979,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Mobility Goal Status G-8979,53297,CDM,G8979,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Mobility Discharge Status G-8980,53298,CDM,G8980,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Mobility Discharge Status G-8980,53299,CDM,G8980,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Mobility Discharge Status G-8980,53300,CDM,G8980,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Mobility Discharge Status G-8980,53301,CDM,G8980,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Mobility Discharge Status G-8980,53302,CDM,G8980,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Mobility Discharge Status G-8980,53303,CDM,G8980,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Mobility Discharge Status G-8980,53304,CDM,G8980,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Body Position Current Status G-8981,53305,CDM,G8981,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Body Position Current Status G-8981,53306,CDM,G8981,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Body Position Current Status G-8981,53307,CDM,G8981,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Body Position Current Status G-8981,53308,CDM,G8981,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Body Position Current Status G-8981,53309,CDM,G8981,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Body Position Current Status G-8981,53310,CDM,G8981,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Body Position Current Status G-8981,53311,CDM,G8981,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Body Position Goal Status G-8982,53312,CDM,G8982,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Body Position Goal Status G-8982,53313,CDM,G8982,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Body Position Goal Status G-8982,53314,CDM,G8982,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Body Position Goal Status G-8982,53315,CDM,G8982,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Body Position Goal Status G-8982,53316,CDM,G8982,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Body Position Goal Status G-8982,53317,CDM,G8982,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Body Position Goal Status G-8982,53318,CDM,G8982,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Body Position DC Status G-8983,53319,CDM,G8983,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Body Position DC Status G-8983,53320,CDM,G8983,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Body Position DC Status G-8983,53321,CDM,G8983,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Body Position DC Status G-8983,53322,CDM,G8983,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Body Position DC Status G-8983,53323,CDM,G8983,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Body Position DC Status G-8983,53324,CDM,G8983,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Body Position DC Status G-8983,53325,CDM,G8983,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Carry Current Status  G-8984,53326,CDM,G8984,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Carry Current Status  G-8984,53327,CDM,G8984,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Carry Current Status  G-8984,53328,CDM,G8984,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Carry Current Status  G-8984,53329,CDM,G8984,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Carry Current Status  G-8984,53330,CDM,G8984,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Carry Current Status  G-8984,53331,CDM,G8984,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Carry Current Status  G-8984,53332,CDM,G8984,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Carry Goal Status G-8985,53333,CDM,G8985,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Carry Goal Status G-8985,53334,CDM,G8985,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Carry Goal Status G-8985,53335,CDM,G8985,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Carry Goal Status G-8985,53336,CDM,G8985,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Carry Goal Status G-8985,53337,CDM,G8985,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Carry Goal Status G-8985,53338,CDM,G8985,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Carry Goal Status G-8985,53339,CDM,G8985,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Carry Discharge Status G-8986,53340,CDM,G8986,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Carry Discharge Status G-8986,53341,CDM,G8986,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Carry Discharge Status G-8986,53342,CDM,G8986,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Carry Discharge Status G-8986,53343,CDM,G8986,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Carry Discharge Status G-8986,53344,CDM,G8986,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Carry Discharge Status G-8986,53345,CDM,G8986,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Carry Discharge Status G-8986,53346,CDM,G8986,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Self-Care Current Status G-8987,53347,CDM,G8987,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Self-Care Current Status G-8987,53348,CDM,G8987,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Self-Care Current Status G-8987,53349,CDM,G8987,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Self-Care Current Status G-8987,53350,CDM,G8987,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Self-Care Current Status G-8987,53351,CDM,G8987,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Self-Care Current Status G-8987,53352,CDM,G8987,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Self-Care Current Status G-8987,53353,CDM,G8987,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Self-Care Goal Status G-8988,53354,CDM,G8988,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Self-Care Goal Status G-8988,53355,CDM,G8988,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired [GCMH] - OT Self-Care Goal Status G-8988,53356,CDM,G8988,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Self-Care Goal Status G-8988,53357,CDM,G8988,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Self-Care Goal Status G-8988,53358,CDM,G8988,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Self-Care Goal Status G-8988,53359,CDM,G8988,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Self-Care Goal Status G-8988,53360,CDM,G8988,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Self-Care Discharge Status G-8989,53361,CDM,G8989,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Self-Care Discharge Status G-8989,53362,CDM,G8989,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Self-Care Discharge Status G-8989,53363,CDM,G8989,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Self-Care Discharge Status G-8989,53364,CDM,G8989,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Self-Care Discharge Status G-8989,53365,CDM,G8989,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Self-Care Discharge Status G-8989,53366,CDM,G8989,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Self-Care Discharge Status G-8989,53367,CDM,G8989,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Other Primary Current Status G-8990,53368,CDM,G8990,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Other Primary Current Status G-8990,53369,CDM,G8990,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Other Primary Current Status G-8990,53370,CDM,G8990,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Other Primary Current Status G-8990,53371,CDM,G8990,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Other Primary Current Status G-8990,53372,CDM,G8990,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Other Primary Current Status G-8990,53373,CDM,G8990,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Other Primary Current Status G-8990,53374,CDM,G8990,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Other Primary Goal Status G-8991,53375,CDM,G8991,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Other Primary Goal Status G-8991,53376,CDM,G8991,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Other Primary Goal Status G-8991,53377,CDM,G8991,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Other Primary Goal Status G-8991,53378,CDM,G8991,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Other Primary Goal Status G-8991,53379,CDM,G8991,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Other Primary Goal Status G-8991,53380,CDM,G8991,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Other Primary Goal Status G-8991,53381,CDM,G8991,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Other Primary Discharge Status G-8992,53382,CDM,G8992,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Other Primary Discharge Status G-8992,53383,CDM,G8992,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Other Primary Discharge Status G-8992,53384,CDM,G8992,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Other Primary Discharge Status G-8992,53385,CDM,G8992,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Other Primary Discharge Status G-8992,53386,CDM,G8992,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Other Primary Discharge Status G-8992,53387,CDM,G8992,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Other Primary Discharge Status G-8992,53388,CDM,G8992,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Subsequent Current Status G-8993,53389,CDM,G8993,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Subsequent Current Status G-8993,53390,CDM,G8993,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Subsequent Current Status G-8993,53391,CDM,G8993,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Subsequent Current Status G-8993,53392,CDM,G8993,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Subsequent Current Status G-8993,53393,CDM,G8993,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Subsequent Current Status G-8993,53394,CDM,G8993,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Subsequent Current Status G-8993,53395,CDM,G8993,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Subsequent Goal Status G-8994,53397,CDM,G8994,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Subsequent Goal Status G-8994,53398,CDM,G8994,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Subsequent Goal Status G-8994,53399,CDM,G8994,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Subsequent Goal Status G-8994,53400,CDM,G8994,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Subsequent Goal Status G-8994,53401,CDM,G8994,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Subsequent Goal Status G-8994,53402,CDM,G8994,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CH 0% impaired - OT Subsequent Discharge Status G-8995,53403,CDM,G8995,CPT,0430,RC,,,facility,inpatient,,,GO|CH,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CI At least 1% but less than 20% impaired - OT Subsequent Discharge Status G-8995,53404,CDM,G8995,CPT,0430,RC,,,facility,inpatient,,,GO|CI,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CJ At least 20% but less than 40% impaired - OT Subsequent Discharge Status G-8995,53405,CDM,G8995,CPT,0430,RC,,,facility,inpatient,,,GO|CJ,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CK At least 40% but less than 60% impaired - OT Subsequent Discharge Status G-8995,53406,CDM,G8995,CPT,0430,RC,,,facility,inpatient,,,GO|CK,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CL At least 60% but less than 80% impaired - OT Subsequent Discharge Status G-8995,53407,CDM,G8995,CPT,0430,RC,,,facility,inpatient,,,GO|CL,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CM At least 80% but less than 100% impaired - OT Subsequent Discharge Status G-8995,53408,CDM,G8995,CPT,0430,RC,,,facility,inpatient,,,GO|CM,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CN 100% impaired - OT Subsequent Discharge Status G-8995,53409,CDM,G8995,CPT,0430,RC,,,facility,inpatient,,,GO|CN,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Severe acute respiratory coronavirus 2 (SARS-CoV-2) vaccine mRNA-LNP preservative free,91307,CDM,91307,CPT,0636,RC,,,facility,inpatient,,,,0.01,0.01,0.01,0.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH LKROLL 18132 1 3/4,2560401,CDM,A5073,CPT,0272,RC,,,facility,inpatient,,,,0.23,0.14,0.19,0.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH LKROLL 18133 2 1/4,2564103,CDM,A5073,CPT,0272,RC,,,facility,inpatient,,,,0.23,0.14,0.19,0.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH LKROLL 18134 2 3/4,2564305,CDM,A5073,CPT,0272,RC,,,facility,inpatient,,,,0.23,0.14,0.19,0.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH DRAINABLE 4 18006,2563405,CDM,,,0272,RC,,,facility,inpatient,,,,0.27,0.16,0.22,0.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH UROSTOMY 1 3/4 18402,2872509,CDM,A5073,CPT,0272,RC,,,facility,inpatient,,,,0.34,0.2,0.28,0.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 2 3/4 FLANGE CERAPLUS 11204,2453508,CDM,,,0272,RC,,,facility,inpatient,,,,0.44,0.26,0.36,0.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 2 1/4 FLANGE CERAPLUS 11203,2454001,CDM,,,0272,RC,,,facility,inpatient,,,,0.45,0.27,0.37,0.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 1 3/4 FLANGE CERAPLUS 11202,2560807,CDM,,,0272,RC,,,facility,inpatient,,,,0.45,0.27,0.37,0.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH ONE PIECE W/BARRIER 2.5,2022305,CDM,,,0272,RC,,,facility,inpatient,,,,0.46,0.28,0.38,0.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - MILEAGE,4037,CDM,,,0770,RC,,,facility,inpatient,,,,0.55,0.33,0.45,0.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
RING SKIN BARRIER 13/16 20MM,2563102,CDM,,,0272,RC,,,facility,inpatient,,,,0.56,0.34,0.46,0.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - CONSULTANT MILEAGE,66801,CDM,,,0942,RC,,,facility,inpatient,,,,0.56,0.34,0.46,0.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH DRAINABLE 1-3/4 18162,2560101,CDM,,,0270,RC,,,facility,inpatient,,,,0.59,0.35,0.48,0.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Dry Socket Paste [MDH] - Paste,72177,CDM,,,0637,RC,11114-0002-92,NDC,facility,inpatient,1,EA,,0.6,0.36,0.49,0.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 4 FLANGE 14206,2563603,CDM,,,0270,RC,,,facility,inpatient,,,,0.65,0.39,0.53,0.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - INSTRUMENT STERILIZATION,34001,CDM,,,0360,RC,,,facility,inpatient,,,,0.65,0.39,0.53,0.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
EXTRACTOR STAPLE SKIN,3177304,CDM,,,0272,RC,,,facility,inpatient,,,,0.67,0.4,0.55,0.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OCUVITE Multiple Vitamins and Minerals Tab [MDH],70084,CDM,,,0250,RC,24208-0387-62,NDC,facility,inpatient,1,EA,,0.69,0.41,0.57,0.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 500 mg Tab,78295,CDM,,,0637,RC,00904-6720-40,NDC,facility,inpatient,1,EA,,0.7,0.42,0.57,0.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER CONVEX 2 3/4 11404 CERAPLUS,2022708,CDM,,,0272,RC,,,facility,inpatient,,,,0.74,0.44,0.61,0.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 2 1/4 CONVEX 11403 CERAPLUS,2022902,CDM,,,0270,RC,,,facility,inpatient,,,,0.74,0.44,0.61,0.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OCUVITE Multiple Vitamins and Minerals Tab [MDH],70084,CDM,,,0250,RC,00904-7735-18,NDC,facility,inpatient,1,EA,,0.75,0.45,0.62,0.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 500 mg Tab [MDH],78295,CDM,,,0637,RC,50580-0451-03,NDC,facility,inpatient,1,EA,,0.76,0.46,0.62,0.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POWDER STOMAHESIVE/KARAYA,2564403,CDM,,,0272,RC,,,facility,inpatient,,,,0.78,0.47,0.64,0.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 1-3/4 14602,2454101,CDM,,,0270,RC,,,facility,inpatient,,,,0.83,0.5,0.68,0.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 80 mg Chew Tab [MDH],78274,CDM,,,0637,RC,15127-0830-04,NDC,facility,inpatient,1,EA,,0.84,0.5,0.69,0.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BELT OSTOMY LRG HOL,2044000,CDM,,,0272,RC,,,facility,inpatient,,,,0.85,0.51,0.7,0.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
COTTON UMBILICAL TAPE 1/8 X 30,3218504,CDM,,,0272,RC,,,facility,inpatient,,,,0.87,0.52,0.71,0.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMAL SALINE 0.9 1000ML B,71723,CDM,,,0270,RC,,,facility,inpatient,,,,0.91,0.55,0.75,0.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALOE VESTA PROTECT OINTMENT,2132706,CDM,,,0270,RC,,,facility,inpatient,,,,0.92,0.55,0.75,0.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 500 mg Tab,78295,CDM,,,0636,RC,00904-6730-61,NDC,facility,inpatient,1,EA,,0.94,0.56,0.77,0.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH DRAINABLE KARAYA 1.5 3274,2454808,CDM,,,0270,RC,,,facility,inpatient,,,,0.97,0.58,0.8,0.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
K-WIRE T-POINT 1.6MM X 285CM,1468901,CDM,,,0270,RC,,,facility,inpatient,,,,1,0.6,0.82,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SENI-CARE MOISTURIZING CREAM,2132209,CDM,,,0270,RC,,,facility,inpatient,,,,1,0.6,0.82,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Miscellaneous MAR Items 10.75 gm Powder,72191,CDM,,,0636,RC,94688-0084-70,NDC,facility,inpatient,1,EA,,1,0.6,0.82,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Pro-Stat Sugar Free Liquid Protein [MDH],Prostat,CDM,,,0636,RC,26794-0410-17,NDC,facility,inpatient,30,ML,,1,0.6,0.82,1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE K-832-H   3-0 SILK BLK,3161001,CDM,,,0272,RC,,,facility,inpatient,,,,1.02,0.61,0.84,1.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE K-833-H   2-0 SILK BLK,3231507,CDM,,,0272,RC,,,facility,inpatient,,,,1.02,0.61,0.84,1.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 1.75 14705,2560606,CDM,,,0270,RC,,,facility,inpatient,,,,1.03,0.62,0.84,1.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE  5% INJ  100ML BA,3006305,CDM,,,0272,RC,,,facility,inpatient,,,,1.03,0.62,0.84,1.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE  5% INJ 50ML BAG,3006503,CDM,,,0272,RC,,,facility,inpatient,,,,1.03,0.62,0.84,1.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-423-H   3-0 VICRYL  F,3255001,CDM,,,0272,RC,,,facility,inpatient,,,,1.05,0.63,0.86,1.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ferrous sulfate 220 mg/5 mL Eli,79968,CDM,,,0637,RC,57896-0709-16,NDC,facility,inpatient,473,ML,,1.07,0.64,0.88,1.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
IRRIGATION SYRINGE TRAY 60ML,CDM,CDM,,,0272,RC,,,facility,inpatient,,,,1.07,0.64,0.88,1.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ferrous sulfate 220 mg/5 mL Oral Elix [MDH],79968,CDM,,,0637,RC,00472-1465-16,NDC,facility,inpatient,473,ML,,1.08,0.65,0.89,1.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PASTE STOMA ADAPT 2 OZ,2018608,CDM,,,0270,RC,,,facility,inpatient,,,,1.09,0.65,0.89,1.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,0.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
TUBE URINARY DRAIN 18 EXT,2028801,CDM,,,0272,RC,,,facility,inpatient,,,,1.11,0.67,0.91,1.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ferrous sulfate 220 mg/5 mL Oral Elix [MDH],79968,CDM,,,0637,RC,50383-0778-16,NDC,facility,inpatient,480,ML,,1.15,0.69,0.94,1.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,0.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Oral Susp 473 mL [MDH],75573,CDM,,,0637,RC,54879-0007-16,NDC,facility,inpatient,473,ML,,1.19,0.71,0.98,1.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING TEGADERM 6 X 8,2094401,CDM,,,0272,RC,,,facility,inpatient,,,,1.2,0.72,0.98,1.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH IRRIGATION 2 1/4 18153,2551004,CDM,,,0272,RC,,,facility,inpatient,,,,1.2,0.72,0.98,1.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",0.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-258-H 3-0 VICRYL CT-1,3229124,CDM,,,0272,RC,,,facility,inpatient,,,,1.23,0.74,1.01,1.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.17,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-338-H   3-0 VICRYL CT,3214503,CDM,,,0272,RC,,,facility,inpatient,,,,1.24,0.74,1.02,1.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH DRAINABLE SUR-FIT 411266 -  2 1/4,2563909,CDM,,,0270,RC,,,facility,inpatient,,,,1.25,0.75,1.02,1.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 80 mg Chew Tab [MDH],78274,CDM,,,0637,RC,00904-5256-46,NDC,facility,inpatient,1,EA,,1.25,0.75,1.02,1.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OWENS SILK,3197005,CDM,,,0272,RC,,,facility,inpatient,,,,1.26,0.76,1.03,1.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J418H,3236616,CDM,,,0272,RC,,,facility,inpatient,,,,1.27,0.76,1.04,1.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VICRYL 4-0 SH 27 VIOLET,3214602,CDM,,,0272,RC,,,facility,inpatient,,,,1.28,0.77,1.05,1.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ferrous sulfate 220 mg/5 mL Eli,79968,CDM,,,0637,RC,54838-0001-80,NDC,facility,inpatient,473,ML,,1.29,0.77,1.06,1.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BAG URINARY DRAIN LRG,2028700,CDM,,,0272,RC,,,facility,inpatient,,,,1.3,0.78,1.07,1.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 500 mg Tab [MDH],78295,CDM,,,0637,RC,00904-1988-61,NDC,facility,inpatient,1,EA,,1.3,0.78,1.07,1.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE LA-54-G   3-0 SILK REEL,3129802,CDM,,,0272,RC,,,facility,inpatient,,,,1.31,0.79,1.07,1.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-347-H    1  VICRYL  C,3171307,CDM,,,0272,RC,,,facility,inpatient,,,,1.32,0.79,1.08,1.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-267-H  0 VICRYL CP-1,3237108,CDM,,,0272,RC,,,facility,inpatient,,,,1.32,0.79,1.08,1.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
TRAY TRACHEOSTOMY CARE KIT,2288003,CDM,,,0272,RC,,,facility,inpatient,,,,1.34,0.8,1.1,1.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PERMA HAND SILK 3-0 KS 30 BLACK,3226002,CDM,,,0272,RC,,,facility,inpatient,,,,1.34,0.8,1.1,1.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE EXCEL GREEN 2.0  X411H,1319919,CDM,,,0272,RC,,,facility,inpatient,,,,1.35,0.81,1.11,1.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.28,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 0.5 mg/5 mL Oral Elix [MDH],75593,CDM,,,0637,RC,00054-3177-63,NDC,facility,inpatient,500,ML,,1.38,0.83,1.13,1.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE A-184-H  3-0 SILK BLK,3179102,CDM,,,0272,RC,,,facility,inpatient,,,,1.4,0.84,1.15,1.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CANNULA TRACH  6MM DISP.,2310609,CDM,A4623,CPT,0274,RC,,,facility,inpatient,,,,1.41,0.85,1.16,1.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CANNULA TRACH 10MM DISP,2310807,CDM,,,0270,RC,,,facility,inpatient,,,,1.41,0.85,1.16,1.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
GEL NORMLGEL WOUND 5GM,2092709,CDM,,,0270,RC,,,facility,inpatient,,,,1.44,0.86,1.18,1.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VALVE HEIMLICH CHEST DRAIN,3208001,CDM,,,0272,RC,,,facility,inpatient,,,,1.44,0.86,1.18,1.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
MASTISOL LIQUID ADHESIVE,3200862,CDM,,,0270,RC,,,facility,inpatient,,,,1.45,0.87,1.19,1.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE LA-53-G   4-0 SILK BLK,3129008,CDM,,,0272,RC,,,facility,inpatient,,,,1.46,0.88,1.2,1.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 5 mg Tab,76520,CDM,,,0636,RC,60687-0122-01,NDC,facility,inpatient,1,EA,,1.47,0.88,1.21,1.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE VICRYL 0 CP-2 27 UNDYED,3171425,CDM,,,0272,RC,,,facility,inpatient,,,,1.49,0.89,1.22,1.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-364-H  0 VICRYL CTX,3232505,CDM,,,0272,RC,,,facility,inpatient,,,,1.5,0.9,1.23,1.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J871H SIZE 1 VICRYL,1329313,CDM,,,0272,RC,,,facility,inpatient,,,,1.51,0.91,1.24,1.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.51,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
(DISCONTINUED - USE 5697171),5694616,CDM,,,0272,RC,,,facility,inpatient,,,,1.51,0.91,1.24,1.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.51,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  675-H    3-0 SILK BLK,3148008,CDM,,,0272,RC,,,facility,inpatient,,,,1.52,0.91,1.25,1.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH UROSTOMY 1 3/4 SUR-FIT NATURA 401544,2560909,CDM,,,0270,RC,,,facility,inpatient,,,,1.55,0.93,1.27,1.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PERMA HAND SILK 3-0 FS-1 18 BLACK,3151101,CDM,,,0272,RC,,,facility,inpatient,,,,1.55,0.93,1.27,1.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 10 mg Tab,76521,CDM,,,0636,RC,60687-0134-01,NDC,facility,inpatient,1,EA,,1.55,0.93,1.27,1.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE VICRYL VCP218H,1249414,CDM,,,0272,RC,,,facility,inpatient,,,,1.57,0.94,1.29,1.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE S-104-H    0  GUT PLAIN,3133000,CDM,,,0272,RC,,,facility,inpatient,,,,1.57,0.94,1.29,1.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  424-H     0  SILK  CT-,3215203,CDM,,,0272,RC,,,facility,inpatient,,,,1.61,0.97,1.32,1.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE K-831-H   4-0 SILK BLK,3231002,CDM,,,0272,RC,,,facility,inpatient,,,,1.62,0.97,1.33,1.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1629H,3287717,CDM,,,0272,RC,,,facility,inpatient,,,,1.63,0.98,1.34,1.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 20 mg Tab [MDH],76525,CDM,,,0636,RC,00143-9738-01,NDC,facility,inpatient,1,EA,,1.63,0.98,1.34,1.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ELECTRODE GROUNDING ADULT,3111006,CDM,,,0272,RC,,,facility,inpatient,,,,1.64,0.98,1.34,1.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-472-H   2-0 VICRYL CP,3257205,CDM,,,0272,RC,,,facility,inpatient,,,,1.64,0.98,1.34,1.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CONVAFOAM ADH SIL 8X8CM,5697171,CDM,,,0270,RC,,,facility,inpatient,,,,1.64,0.98,1.34,1.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 5 mg Tab [MDH],76520,CDM,,,0636,RC,00591-5052-01,NDC,facility,inpatient,1,EA,,1.65,0.99,1.35,1.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING X-LRG LONG KNEE A-E,2120602,CDM,,,0270,RC,,,facility,inpatient,,,,1.67,1,1.37,1.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DUODERM SIGNAL 10X10,2290801,CDM,,,0270,RC,,,facility,inpatient,,,,1.67,1,1.37,1.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ADAPTER URETHERAL CATHETER,3225234,CDM,,,0272,RC,,,facility,inpatient,,,,1.67,1,1.37,1.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING TEGADERM 8 X 12,2093908,CDM,,,0272,RC,,,facility,inpatient,,,,1.68,1.01,1.38,1.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMAL SALINE .9% 50ML BAG,3017708,CDM,,,0272,RC,,,facility,inpatient,,,,1.69,1.01,1.39,1.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER KIT FEMALE  8FR,2200404,CDM,,,0272,RC,,,facility,inpatient,,,,1.7,1.02,1.39,1.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING SM REG KNEE A-E,2118002,CDM,,,0270,RC,,,facility,inpatient,,,,1.71,1.03,1.4,1.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SKIN BARRIER 33-45MM,2563318,CDM,,,0270,RC,,,facility,inpatient,,,,1.71,1.03,1.4,1.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMAL SALINE .9% INJ  100ML BAG,3023102,CDM,,,0270,RC,,,facility,inpatient,,,,1.71,1.03,1.4,1.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FEMALE CATH KIT CHILD 5 FR,5696919,CDM,,,0272,RC,,,facility,inpatient,,,,1.73,1.04,1.42,1.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.42,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 20 mg Tab,76525,CDM,,,0636,RC,60687-0145-01,NDC,facility,inpatient,1,EA,,1.73,1.04,1.42,1.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.42,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND PLAIN 1/2,2193203,CDM,,,0270,RC,,,facility,inpatient,,,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE N-863-H   2-0 GUT PLAIN,3163007,CDM,,,0272,RC,,,facility,inpatient,,,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Acetic Acid - 1/2% Solution [MDH],70291,CDM,,,0637,RC,99999-9999-69,NDC,facility,inpatient,1500,ML,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
L.E.T. Solution [MDH],71167,CDM,,,0637,RC,99999-9999-38,NDC,facility,inpatient,1,GM,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Dexlansoprazole Cap Delayed Release 30 MG [MDH],71698,CDM,,,0637,RC,35356-0566-30,NDC,facility,inpatient,1,EA,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Levocetirizine Dihydrochloride Tab 5 MG [MDH],71712,CDM,,,0637,RC,54868-5829-00,NDC,facility,inpatient,1,EA,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Zaleplon Cap 5 MG [MDH],71741,CDM,,,0637,RC,35356-0574-30,NDC,facility,inpatient,1,EA,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Menthol/benzocaine Lozenge 3.6 mg/15 mg [MDH],72014,CDM,,,0637,RC,54569-2807-00,NDC,facility,inpatient,1,EA,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Acetic Acid - 1/4% Solution [MDH],72037,CDM,,,0637,RC,99999-9999-68,NDC,facility,inpatient,1500,ML,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Fortified tobramycin 15 mg/mL eye drops 1 EA Liquid,72306,CDM,,,0637,RC,98889-7789-10,NDC,facility,inpatient,1,EA,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Neomycin Enema [MDH],75515,CDM,,,0637,RC,99999-9999-37,NDC,facility,inpatient,200,ML,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 200 mg Tab [MDH],75889,CDM,,,0637,RC,68084-0787-95,NDC,facility,inpatient,1,EA,,1.75,1.05,1.43,1.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND PLAIN 1/4,2192700,CDM,,,0272,RC,,,facility,inpatient,,,,1.76,1.06,1.44,1.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  852-H    3-0 GUT PLAIN,3219601,CDM,,,0272,RC,,,facility,inpatient,,,,1.76,1.06,1.44,1.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cholecalciferol 10 mcg/mL Liq *,71792,CDM,,,0250,RC,71399-7401-05,NDC,facility,inpatient,50,ML,,1.76,1.06,1.44,1.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  662-H    4-0 ETHILON F,3146002,CDM,,,0272,RC,,,facility,inpatient,,,,1.78,1.07,1.46,1.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DSE SMOKE EVACUATION TUBING,3182755,CDM,,,0272,RC,,,facility,inpatient,,,,1.78,1.07,1.46,1.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,70770,CDM,,,0637,RC,69618-0017-02,NDC,facility,inpatient,1,EA,,1.78,1.07,1.46,1.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sodium bicarbonate 650 mg Tab [MDH],77145,CDM,,,0637,RC,00677-0131-10,NDC,facility,inpatient,1,EA,,1.78,1.07,1.46,1.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium carbonate 500 mg Chew Tab [MDH],78238,CDM,,,0250,RC,24385-0478-47,NDC,facility,inpatient,1,EA,,1.78,1.07,1.46,1.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Tab,78272,CDM,,,0637,RC,00536-1327-10,NDC,facility,inpatient,1,EA,,1.78,1.07,1.46,1.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Tab,78272,CDM,,,0637,RC,00904-6719-60,NDC,facility,inpatient,1,EA,,1.78,1.07,1.46,1.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING LRG REG KNEE A-E,2120008,CDM,,,0270,RC,,,facility,inpatient,,,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ascorbic acid 250 mg Tab,70745,CDM,,,0637,RC,20555-0001-00,NDC,facility,inpatient,1,EA,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 325 mg Tab *,70785,CDM,,,0637,RC,57896-0921-01,NDC,facility,inpatient,1,EA,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 325 mg Tab,70785,CDM,,,0637,RC,69618-0015-01,NDC,facility,inpatient,1,EA,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyanocobalamin 100 mcg Tab,71336,CDM,,,0637,RC,80681-0071-00,NDC,facility,inpatient,1,EA,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
folic acid 0.4 mg Tab,71422,CDM,,,0637,RC,51645-0932-01,NDC,facility,inpatient,1,EA,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
folic acid 0.4 mg Tab,71422,CDM,,,0637,RC,80681-0099-00,NDC,facility,inpatient,1,EA,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium-vitamin D 250 mg-125 units Tab [MDH],75915,CDM,,,0637,RC,00904-1882-60,NDC,facility,inpatient,1,EA,,1.79,1.07,1.47,1.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-433-H   5-0 VICRYL TF,3216409,CDM,,,0272,RC,,,facility,inpatient,,,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Oral EC Tab [MDH],70770,CDM,,,0637,RC,00904-7704-80,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diphenhydrAMINE 25 mg Cap,71050,CDM,,,0637,RC,71399-1027-01,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyanocobalamin 100 mcg Tab [MDH],71336,CDM,,,0637,RC,00536-3542-01,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate sodium 100 mg Cap,71855,CDM,,,0637,RC,00904-6998-60,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate sodium 100 mg Cap,71855,CDM,,,0637,RC,00904-7280-60,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
simethicone 40mg chew tab (1/2) [MDH],71884,CDM,,,0637,RC,00904-5068-60A,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
simethicone 80 mg Tab,75340,CDM,,,0637,RC,24385-0118-78,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thiamine 50 mg Tab [MDH],77876,CDM,,,0637,RC,00536-4678-01,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium carbonate 500 mg Chew Tab [MDH],78238,CDM,,,0637,RC,00904-6412-92,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Tab,78272,CDM,,,0637,RC,00536-1327-01,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pyridoxine 50 mg Tab,78597,CDM,,,0637,RC,10006-0700-12,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,79055,CDM,,,0636,RC,00904-6794-89,NDC,facility,inpatient,1,EA,,1.8,1.08,1.48,1.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STERNUM SAW BLADE OSCILLATING 10X35X.6MM,1204919,CDM,,,0272,RC,,,facility,inpatient,,,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OSTOMY SYSTEM 4 TWO-PIECE 19156,2455008,CDM,,,0270,RC,,,facility,inpatient,,,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,70770,CDM,,,0637,RC,00536-1234-41,NDC,facility,inpatient,1,EA,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Oral EC Tab [MDH],70770,CDM,,,0637,RC,62107-0027-26,NDC,facility,inpatient,1,EA,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zinc sulfate 220 mg Cap [MDH],75885,CDM,,,0637,RC,00904-5332-60,NDC,facility,inpatient,1,EA,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate-senna 50 mg-8.6 mg Tab,76980,CDM,,,0637,RC,57896-0455-01,NDC,facility,inpatient,1,EA,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium carbonate 500 mg Chew Tab [MDH],78238,CDM,,,0637,RC,00182-1139-20,NDC,facility,inpatient,1,EA,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium carbonate 500 mg Chew Tab [MDH],78238,CDM,,,0637,RC,00766-0741-52,NDC,facility,inpatient,1,EA,,1.81,1.09,1.48,1.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING MED REG KNEE A-E,2119000,CDM,,,0270,RC,,,facility,inpatient,,,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
multivitamin Vitamin B Complex with C Tab,70330,CDM,,,0637,RC,80681-0126-00,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ascorbic acid 250 mg Tab [MDH],70745,CDM,,,0637,RC,00904-0522-60,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traZODone 25 mg tab (1/2) [MDH],71887,CDM,,,0637,RC,68084-0124-11A,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cholecalciferol (Vitamin D) 1000 intl units Tab [MDH],72051,CDM,,,0250,RC,00904-5824-93,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen/aspirin/caffeine 250 mg-250 mg-65 mg Tab,72084,CDM,,,0637,RC,00536-1326-01,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyanocobalamin 500 mcg Tab [MDH],72234,CDM,,,0637,RC,80681-0072-00,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sodium bicarbonate 325 mg Tab [MDH],72297,CDM,,,0637,RC,00536-1046-10,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 5 mg Tab [MDH],76520,CDM,,,0636,RC,00054-8724-25,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate-senna 50 mg-8.6 mg Tab [MDH],76980,CDM,,,0637,RC,00536-1248-01,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Multiple Vitamins Tab (Tab-A-Vite) [MDH],78593,CDM,,,0637,RC,00904-0530-60,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pyridoxine 50 mg Tab [MDH],78597,CDM,,,0637,RC,00904-0520-60,NDC,facility,inpatient,1,EA,,1.82,1.09,1.49,1.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab *,70770,CDM,,,0637,RC,46122-0598-87,NDC,facility,inpatient,1,EA,,1.83,1.1,1.5,1.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sodium bicarbonate 650 mg Tab,77145,CDM,,,0637,RC,00536-1047-10,NDC,facility,inpatient,1,EA,,1.83,1.1,1.5,1.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sodium bicarbonate 650 mg Tab [MDH],77145,CDM,,,0637,RC,00536-4544-10,NDC,facility,inpatient,1,EA,,1.83,1.1,1.5,1.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thiamine 50 mg Tab,77876,CDM,,,0637,RC,10006-0730-19,NDC,facility,inpatient,1,EA,,1.83,1.1,1.5,1.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thiamine 50 mg Tab [MDH],77876,CDM,,,0250,RC,80681-0097-00,NDC,facility,inpatient,1,EA,,1.83,1.1,1.5,1.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
folic acid 0.4 mg Tab [MDH],71422,CDM,,,0637,RC,00904-3197-60,NDC,facility,inpatient,1,EA,,1.84,1.1,1.51,1.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Melatonin 3 mg tab [MDH],71832,CDM,,,0637,RC,03504-6003-90,NDC,facility,inpatient,1,EA,,1.84,1.1,1.51,1.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate sodium 100 mg Cap [MDH],71855,CDM,,,0637,RC,63739-0478-01,NDC,facility,inpatient,1,EA,,1.84,1.1,1.51,1.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen/aspirin/caffeine 250 mg-250 mg-65 mg Tab [MDH],72084,CDM,,,0637,RC,00904-5135-59,NDC,facility,inpatient,1,EA,,1.84,1.1,1.51,1.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium-vitamin D 250 mg-125 units Tab [MDH],75915,CDM,,,0637,RC,00904-1882-61,NDC,facility,inpatient,1,EA,,1.84,1.1,1.51,1.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
vitamin E 90 mg Cap,78600,CDM,,,0637,RC,87701-0407-53,NDC,facility,inpatient,1,EA,,1.84,1.1,1.51,1.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE SA-63-H   4-0 SILK BLK,3154709,CDM,,,0272,RC,,,facility,inpatient,,,,1.85,1.11,1.52,1.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Vitamin B Complex with C Tab [MDH],70330,CDM,,,0637,RC,00904-0260-13,NDC,facility,inpatient,1,EA,,1.85,1.11,1.52,1.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diphenhydrAMINE 25 mg Cap [MDH],71050,CDM,,,0636,RC,00904-5306-61,NDC,facility,inpatient,1,EA,,1.85,1.11,1.52,1.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bisacodyl 5 mg Tab,72905,CDM,,,0637,RC,46122-0529-78,NDC,facility,inpatient,1,EA,,1.85,1.11,1.52,1.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 1 mg Tab,76513,CDM,,,0636,RC,60219-1705-01,NDC,facility,inpatient,1,EA,,1.85,1.11,1.52,1.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 12FR  5CC,2067209,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 14FR  5CC,2067308,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SLING ARM MUSLIN CRADLE LG 8025-04,2226300,CDM,,,0270,RC,,,facility,inpatient,,,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Oral EC Tab [MDH],70770,CDM,,,0637,RC,00904-7704-18,NDC,facility,inpatient,1,EA,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,70770,CDM,,,0637,RC,63739-0522-10,NDC,facility,inpatient,1,EA,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
omega-3 polyunsaturated fatty acids 1000 mg Cap [MDH],71351,CDM,,,0250,RC,47469-0009-28,NDC,facility,inpatient,1,EA,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traMADol 25mg tab (1/2) [MDH],71886,CDM,,,0637,RC,51079-0991-01A,NDC,facility,inpatient,1,EA,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cholecalciferol 1000 intl units Tab,72051,CDM,,,0250,RC,20555-0033-00,NDC,facility,inpatient,1,EA,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
simethicone 80 mg Chew Tab [MDH],75340,CDM,,,0637,RC,00904-5068-60,NDC,facility,inpatient,1,EA,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium-vitamin D 250 mg-125 units Tab,75915,CDM,,,0250,RC,20555-0025-00,NDC,facility,inpatient,1,EA,,1.86,1.12,1.53,1.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE JB-260   0  VICRYL,2059909,CDM,,,0272,RC,,,facility,inpatient,,,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-417-H   2-0 VICRYL  S,3171506,CDM,,,0272,RC,,,facility,inpatient,,,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,70770,CDM,,,0637,RC,63739-0212-10,NDC,facility,inpatient,1,EA,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diphenhydrAMINE 25 mg Cap [MDH],71050,CDM,,,0637,RC,00904-7237-61,NDC,facility,inpatient,1,EA,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyanocobalamin 1000 mcg Tab [MDH],71483,CDM,,,0637,RC,00536-3556-01,NDC,facility,inpatient,1,EA,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
senna 8.6 mg Tab,76975,CDM,,,0637,RC,00904-7252-61,NDC,facility,inpatient,1,EA,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pseudoephedrine 60 mg Tab [MDH],77375,CDM,,,0637,RC,00904-5125-59,NDC,facility,inpatient,1,EA,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
vitamin E 90 mg Cap [MDH],78600,CDM,,,0637,RC,80681-0159-00,NDC,facility,inpatient,1,EA,,1.87,1.12,1.53,1.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 26FR  5CC,2070104,CDM,A4338,CPT,0274,RC,,,facility,inpatient,,,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 24FR  5CC,2075905,CDM,A4338,CPT,0274,RC,,,facility,inpatient,,,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE H-821-H   4-0 GUT PLAIN,3159203,CDM,,,0272,RC,,,facility,inpatient,,,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-316-H   3-0 VICRYL  S,3170804,CDM,,,0272,RC,,,facility,inpatient,,,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-416-H   3-0 VICRYL,3266203,CDM,,,0272,RC,,,facility,inpatient,,,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,70770,CDM,,,0637,RC,63739-0212-02,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 325 mg Oral EC Tab [MDH],70785,CDM,,,0637,RC,63739-0523-01,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 12.5 mg tab (1/2) [MDH],71875,CDM,,,0250,RC,62584-0265-11A,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
spironolactone 12.5 mg (1/2)[MDH],71987,CDM,,,0637,RC,68084-0206-11A,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylPREDNISolone 4 mg Tab [MDH],74955,CDM,,,0636,RC,00247-1365-30,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sodium bicarbonate 650 mg Tab [MDH],77145,CDM,,,0637,RC,00223-1721-01,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pseudoephedrine 30 mg Tab [MDH],77370,CDM,,,0637,RC,00904-5053-24,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pseudoephedrine 30 mg Tab,77370,CDM,,,0637,RC,00904-6337-24,NDC,facility,inpatient,1,EA,,1.88,1.13,1.54,1.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab [MDH],70770,CDM,,,0637,RC,63739-0522-01,NDC,facility,inpatient,1,EA,,1.89,1.13,1.55,1.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate sodium 100 mg Cap,71855,CDM,,,0637,RC,00904-7183-61,NDC,facility,inpatient,1,EA,,1.89,1.13,1.55,1.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bisacodyl 5 mg Oral EC Tab [MDH],72905,CDM,,,0637,RC,00904-7927-60,NDC,facility,inpatient,1,EA,,1.89,1.13,1.55,1.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PHENobarbital 60 mg Tab [MDH],76325,CDM,,,0637,RC,64125-0902-01,NDC,facility,inpatient,1,EA,,1.89,1.13,1.55,1.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Multiple Vitamins Tab (Tab-A-Vite) [MDH],78593,CDM,,,0250,RC,00904-0530-61,NDC,facility,inpatient,1,EA,,1.89,1.13,1.55,1.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE X-519-H    2  ETHIBOND,3270003,CDM,,,0272,RC,,,facility,inpatient,,,,1.9,1.14,1.56,1.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
omega-3 polyunsaturated fatty acids 1000 mg Cap [MDH],71351,CDM,,,0637,RC,47469-0040-40,NDC,facility,inpatient,1,EA,,1.9,1.14,1.56,1.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 10 mg Tab,76579,CDM,,,0637,RC,00904-6798-61,NDC,facility,inpatient,1,EA,,1.9,1.14,1.56,1.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Tab,78272,CDM,,,0636,RC,00904-6773-61,NDC,facility,inpatient,1,EA,,1.9,1.14,1.56,1.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,79055,CDM,,,0637,RC,63739-0434-02,NDC,facility,inpatient,1,EA,,1.9,1.14,1.56,1.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ascorbic acid 500 mg Tab [MDH],70061,CDM,,,0637,RC,00904-0523-61,NDC,facility,inpatient,1,EA,,1.91,1.15,1.57,1.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ferrous sulfate 325 mg Tab [MDH],73300,CDM,,,0637,RC,00904-7591-61,NDC,facility,inpatient,1,EA,,1.91,1.15,1.57,1.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Tab [MDH],78272,CDM,,,0637,RC,00904-1982-61,NDC,facility,inpatient,1,EA,,1.91,1.15,1.57,1.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ENDO-GUARD BITE BLOCK,3281602,CDM,,,0272,RC,,,facility,inpatient,,,,1.92,1.15,1.57,1.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
melatonin 3 mg Tab,71832,CDM,,,0637,RC,87701-0408-13,NDC,facility,inpatient,1,EA,,1.92,1.15,1.57,1.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bisacodyl 5 mg Oral EC Tab [MDH],72905,CDM,,,0637,RC,00904-6407-61,NDC,facility,inpatient,1,EA,,1.92,1.15,1.57,1.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
senna 8.6 mg Tab,76975,CDM,,,0637,RC,46122-0575-78,NDC,facility,inpatient,1,EA,,1.92,1.15,1.57,1.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1671-H    3-0 ETHILON F,3214902,CDM,,,0272,RC,,,facility,inpatient,,,,1.93,1.16,1.58,1.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
senna 8.6 mg Tab [MDH],76975,CDM,,,0637,RC,00904-5165-61,NDC,facility,inpatient,1,EA,,1.93,1.16,1.58,1.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
senna 8.6 mg Tab [MDH],76975,CDM,,,0637,RC,00904-6522-61,NDC,facility,inpatient,1,EA,,1.93,1.16,1.58,1.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Chew Tab [MDH],79055,CDM,,,0637,RC,66553-0002-01,NDC,facility,inpatient,1,EA,,1.93,1.16,1.58,1.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg Tab,79500,CDM,,,0637,RC,00904-6689-61,NDC,facility,inpatient,1,EA,,1.93,1.16,1.58,1.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  607-G  3-0 MONOFI FS-2,3170502,CDM,,,0272,RC,,,facility,inpatient,,,,1.94,1.16,1.59,1.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-214-H   4-0 VICRYL  R,3196304,CDM,,,0272,RC,,,facility,inpatient,,,,1.94,1.16,1.59,1.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 200 mg Tab [MDH],75209,CDM,,,0637,RC,00904-7914-61,NDC,facility,inpatient,1,EA,,1.94,1.16,1.59,1.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sodium chloride 1 g Tab [MDH],77155,CDM,,,0637,RC,00223-1760-01,NDC,facility,inpatient,1,EA,,1.94,1.16,1.59,1.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ondansetron 2 mg/mL Sol,79008,CDM,,,0636,RC,23155-0547-42,NDC,facility,inpatient,2,ML,,1.94,1.16,1.59,1.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND IODOFORM 1/2,2193005,CDM,,,0270,RC,,,facility,inpatient,,,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-698-H    0  VICRYL OS,3160706,CDM,,,0272,RC,,,facility,inpatient,,,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 20 mg Tab,70057,CDM,,,0637,RC,00904-6799-61,NDC,facility,inpatient,1,EA,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-oxycodone 325 mg-5 mg Tab,71508,CDM,,,0636,RC,42858-0102-01,NDC,facility,inpatient,1,EA,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide 25 mg Tab,73820,CDM,,,0637,RC,16729-0183-01,NDC,facility,inpatient,1,EA,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide 25 mg Tab,73820,CDM,,,0637,RC,29300-0128-01,NDC,facility,inpatient,1,EA,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 10 mg Tab [MDH],76521,CDM,,,0636,RC,00054-0017-20,NDC,facility,inpatient,1,EA,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tetracycline 250 mg Cap [MDH],77400,CDM,,,0636,RC,00172-2416-10,NDC,facility,inpatient,1,EA,,1.95,1.17,1.6,1.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-422-H   4-0 VICRYL  F,3171703,CDM,,,0272,RC,,,facility,inpatient,,,,1.96,1.18,1.61,1.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
heparin flush 10 units/mL Sol,70311,CDM,,,0636,RC,08290-3064-13,NDC,facility,inpatient,3,ML,,1.96,1.18,1.61,1.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium oxide 400 mg Tab,70327,CDM,,,0637,RC,10006-0700-28,NDC,facility,inpatient,1,EA,,1.96,1.18,1.61,1.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab,70815,CDM,,,0636,RC,00904-6007-61,NDC,facility,inpatient,1,EA,,1.96,1.18,1.61,1.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 20 mg Tab,74557,CDM,,,0637,RC,00904-7177-61,NDC,facility,inpatient,1,EA,,1.96,1.18,1.61,1.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,79055,CDM,,,0637,RC,00904-6794-30,NDC,facility,inpatient,1,EA,,1.96,1.18,1.61,1.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE X-517-H    0  ETHIBOND,3259102,CDM,,,0272,RC,,,facility,inpatient,,,,1.97,1.18,1.62,1.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meclizine 12.5 mg Tab [MDH],70555,CDM,,,0637,RC,00536-1017-01,NDC,facility,inpatient,1,EA,,1.97,1.18,1.62,1.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium oxide 200 mg tab (1/2) [MDH],71871,CDM,,,0637,RC,63739-0354-10A,NDC,facility,inpatient,1,EA,,1.97,1.18,1.62,1.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 40 mg Tab,74555,CDM,,,0637,RC,00904-7178-61,NDC,facility,inpatient,1,EA,,1.97,1.18,1.62,1.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
simethicone 80 mg Chew Tab [MDH],75340,CDM,,,0637,RC,63739-0225-10,NDC,facility,inpatient,1,EA,,1.97,1.18,1.62,1.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Pediatric Multiple Vitamins with Iron Oral Liq 50 mL [MDH],76415,CDM,,,0637,RC,00536-8530-80,NDC,facility,inpatient,50,ML,,1.98,1.19,1.62,1.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Chew Tab [MDH],79055,CDM,,,0637,RC,63739-0434-01,NDC,facility,inpatient,1,EA,,1.98,1.19,1.62,1.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND PLAIN 1,2193708,CDM,,,0270,RC,,,facility,inpatient,,,,1.99,1.19,1.63,1.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OLANZapine 1.25 mg (1/2) [MDH],71968,CDM,,,0637,RC,42292-0012-01A,NDC,facility,inpatient,1,EA,,1.99,1.19,1.63,1.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lactase 3000 units Tab,75142,CDM,,,0637,RC,24385-0149-76,NDC,facility,inpatient,1,EA,,1.99,1.19,1.63,1.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND IODOFORM 1,2193500,CDM,,,0270,RC,,,facility,inpatient,,,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-345-H  2-0 VICRYL  CT,3215005,CDM,,,0272,RC,,,facility,inpatient,,,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-346-H    O  VICRYL  C,3215500,CDM,,,0272,RC,,,facility,inpatient,,,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Heparin Lock Flush - 500unit/5mL syringe,71531,CDM,,,0636,RC,08290-3064-24,NDC,facility,inpatient,5,ML,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab,76118,CDM,,,0637,RC,63739-0645-10,NDC,facility,inpatient,1,EA,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 10 mg Tab,76521,CDM,,,0636,RC,60687-0914-01,NDC,facility,inpatient,1,EA,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine pamoate 25 mg Cap,78575,CDM,,,0636,RC,50268-0398-50,NDC,facility,inpatient,1,EA,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pyridoxine 50 mg Tab [MDH],78597,CDM,,,0637,RC,61748-0095-01,NDC,facility,inpatient,1,EA,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zolpidem 5 mg Tab [MDH],79985,CDM,,,0637,RC,00904-6082-61,NDC,facility,inpatient,1,EA,,2,1.2,1.64,2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 25 mg Tab [MDH],70102,CDM,,,0637,RC,62584-0265-01,NDC,facility,inpatient,1,EA,,2.01,1.21,1.65,2.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 10 mg Tab,71433,CDM,,,0637,RC,68001-0494-06,NDC,facility,inpatient,1,EA,,2.01,1.21,1.65,2.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
polycarbophil 625 mg Tab [MDH],73341,CDM,,,0637,RC,00536-4306-08,NDC,facility,inpatient,1,EA,,2.01,1.21,1.65,2.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 3.125 mg Tab,81687,CDM,,,0637,RC,00904-7305-61,NDC,facility,inpatient,1,EA,,2.01,1.21,1.65,2.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meloxicam 7.5 mg Tab [MDH],81971,CDM,,,0637,RC,50268-0525-11,NDC,facility,inpatient,1,EA,,2.01,1.21,1.65,2.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND IODOFORM 1/4,2192502,CDM,,,0270,RC,,,facility,inpatient,,,,2.02,1.21,1.66,2.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-344-H   3-0 VICRYL CT,3256603,CDM,,,0272,RC,,,facility,inpatient,,,,2.02,1.21,1.66,2.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FLUoxetine 20 mg Cap,76712,CDM,,,0637,RC,00904-7346-61,NDC,facility,inpatient,1,EA,,2.02,1.21,1.66,2.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine pamoate 25 mg Cap,78575,CDM,,,0636,RC,60687-0696-01,NDC,facility,inpatient,1,EA,,2.02,1.21,1.66,2.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING X-LNG REG KNEE A-E,2120305,CDM,,,0270,RC,,,facility,inpatient,,,,2.03,1.22,1.66,2.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-266-H    2-0 VICRYL,3196402,CDM,,,0272,RC,,,facility,inpatient,,,,2.03,1.22,1.66,2.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 12.5 mg Tab,71402,CDM,,,0637,RC,00904-7307-61,NDC,facility,inpatient,1,EA,,2.03,1.22,1.66,2.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 600 mg Tab,75216,CDM,,,0636,RC,63739-0684-10,NDC,facility,inpatient,1,EA,,2.03,1.22,1.66,2.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zinc sulfate 220 mg Cap,75885,CDM,,,0637,RC,68585-0008-01,NDC,facility,inpatient,1,EA,,2.03,1.22,1.66,2.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 1 mg Tab [MDH],76513,CDM,,,0636,RC,00054-8739-25,NDC,facility,inpatient,1,EA,,2.03,1.22,1.66,2.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zinc sulfate 220 mg Cap [MDH],75885,CDM,,,0637,RC,00731-0401-06,NDC,facility,inpatient,1,EA,,2.04,1.22,1.67,2.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE  5% ADVAN 100ML B,3007204,CDM,,,0272,RC,,,facility,inpatient,,,,2.05,1.23,1.68,2.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8423-H    2-0 PROLENE C,3170309,CDM,,,0272,RC,,,facility,inpatient,,,,2.05,1.23,1.68,2.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 6.25 mg Tab,70211,CDM,,,0637,RC,00904-7306-61,NDC,facility,inpatient,1,EA,,2.05,1.23,1.68,2.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
benztropine 0.5 mg Tab [MDH],71536,CDM,,,0637,RC,68084-0381-01,NDC,facility,inpatient,1,EA,,2.05,1.23,1.68,2.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J869H  2-O VICRYL CP-2,1333717,CDM,,,0272,RC,,,facility,inpatient,,,,2.06,1.24,1.69,2.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CORD BIPOLAR FORCEPS CAUTERY,3109407,CDM,,,0272,RC,,,facility,inpatient,,,,2.06,1.24,1.69,2.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aminophylline 200 mg Tab [MDH],70447,CDM,,,0637,RC,49999-0550-00,NDC,facility,inpatient,1,EA,,2.06,1.24,1.69,2.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloNIDine 0.05 mg (1/2 of 0.1mg) Tab [MDH],72198,CDM,,,0637,RC,5107929901,NDC,facility,inpatient,1,EA,,2.06,1.24,1.69,2.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide 25 mg Tab [MDH],73820,CDM,,,0637,RC,63739-0128-10,NDC,facility,inpatient,1,EA,,2.06,1.24,1.69,2.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lactase 3000 units Tab [MDH],75142,CDM,,,0637,RC,00904-5224-52,NDC,facility,inpatient,1,EA,,2.06,1.24,1.69,2.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PERMA HAND SILK 4-0 FS-2 18 BLACK,3150004,CDM,,,0272,RC,,,facility,inpatient,,,,2.07,1.24,1.7,2.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  632-G  3-0 SILK X-1,3270107,CDM,,,0272,RC,,,facility,inpatient,,,,2.07,1.24,1.7,2.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,70770,CDM,,,0637,RC,77333-0031-20,NDC,facility,inpatient,1,EA,,2.07,1.24,1.7,2.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 50 mg Tab [MDH],74695,CDM,,,0637,RC,62584-0266-01,NDC,facility,inpatient,1,EA,,2.07,1.24,1.7,2.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prochlorperazine 5 mg Tab,71955,CDM,,,0636,RC,59746-0113-06,NDC,facility,inpatient,1,EA,,2.08,1.25,1.71,2.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prochlorperazine 5 mg Tab,71955,CDM,,,0636,RC,68462-0889-01,NDC,facility,inpatient,1,EA,,2.08,1.25,1.71,2.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prochlorperazine 5 mg Tab,71955,CDM,,,0636,RC,69452-0309-20,NDC,facility,inpatient,1,EA,,2.08,1.25,1.71,2.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexAMETHasone 0.5 mg Tab,72365,CDM,,,0637,RC,60505-6249-01,NDC,facility,inpatient,1,EA,,2.08,1.25,1.71,2.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexAMETHasone 0.5 mg Tab,72365,CDM,,,0637,RC,70954-0398-10,NDC,facility,inpatient,1,EA,,2.08,1.25,1.71,2.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 20 mg Tab [MDH],76525,CDM,,,0636,RC,00054-0018-20,NDC,facility,inpatient,1,EA,,2.08,1.25,1.71,2.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 81 mg Tab,79055,CDM,,,0637,RC,77333-0049-20,NDC,facility,inpatient,1,EA,,2.08,1.25,1.71,2.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 100 mg Cap,70221,CDM,,,0637,RC,00904-6665-61,NDC,facility,inpatient,1,EA,,2.09,1.25,1.71,2.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 10 mEq Tab,71474,CDM,,,0250,RC,00245-5317-11,NDC,facility,inpatient,1,EA,,2.09,1.25,1.71,2.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lithium 150 mg Cap [MDH],71851,CDM,,,0637,RC,00054-2526-25,NDC,facility,inpatient,1,EA,,2.09,1.25,1.71,2.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate sodium 100 mg Cap [MDH],71855,CDM,,,0637,RC,62584-0683-01,NDC,facility,inpatient,1,EA,,2.09,1.25,1.71,2.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 20 mg Tab,74557,CDM,,,0637,RC,69315-0116-01,NDC,facility,inpatient,1,EA,,2.09,1.25,1.71,2.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium oxide 400 mg Tab [MDH],70327,CDM,,,0637,RC,60258-0171-01,NDC,facility,inpatient,1,EA,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium oxide 400 mg Tab [MDH],70327,CDM,,,0637,RC,68585-0006-41,NDC,facility,inpatient,1,EA,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcium carbonate-magnesium chloride 112 mg-64 mg Tab [MDH],71519,CDM,,,0637,RC,68585-0005-75,NDC,facility,inpatient,1,EA,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 10 mg Tab (1/2) UD [MDH],72078,CDM,,,0637,RC,51079-0072-20,NDC,facility,inpatient,1,EA,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide 25 mg Tab [MDH],73820,CDM,,,0637,RC,68084-0086-01,NDC,facility,inpatient,1,EA,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 10 mg Tab [MDH],76705,CDM,,,0637,RC,05976-2374-22,NDC,facility,inpatient,1,EA,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine pamoate 25 mg Cap [MDH],78575,CDM,,,0636,RC,68084-0847-01,NDC,facility,inpatient,1,EA,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ondansetron 2 mg/mL Sol,79008,CDM,,,0636,RC,70860-0776-02,NDC,facility,inpatient,2,ML,,2.1,1.26,1.72,2.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PERMA HAND SILK 2-0 FSL 18 BLACK,3149006,CDM,,,0272,RC,,,facility,inpatient,,,,2.11,1.27,1.73,2.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 20 mg Tab [MDH],70057,CDM,,,0637,RC,60687-0333-01,NDC,facility,inpatient,1,EA,,2.11,1.27,1.73,2.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
trihexyphenidyl 2 mg Tab [MDH],70720,CDM,,,0637,RC,62584-0886-01,NDC,facility,inpatient,1,EA,,2.11,1.27,1.73,2.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
iron polysaccharide (as elemental iron) 150 mg Cap,75625,CDM,,,0637,RC,00904-5395-61,NDC,facility,inpatient,1,EA,,2.11,1.27,1.73,2.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 10 mg Tab,76579,CDM,,,0636,RC,60687-0325-01,NDC,facility,inpatient,1,EA,,2.11,1.27,1.73,2.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL SOD CHL .9% INJ ADVAN 100M,3007402,CDM,,,0270,RC,,,facility,inpatient,,,,2.12,1.27,1.74,2.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 5 mg Tab,71383,CDM,,,0637,RC,00904-7122-61,NDC,facility,inpatient,1,EA,,2.12,1.27,1.74,2.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traZODone 50 mg Tab,72502,CDM,,,0636,RC,60687-0443-01,NDC,facility,inpatient,1,EA,,2.12,1.27,1.74,2.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 20 mg Tab [MDH],74557,CDM,,,0636,RC,00172-2908-60,NDC,facility,inpatient,1,EA,,2.12,1.27,1.74,2.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 100 mg Tab [MDH],74694,CDM,,,0637,RC,62584-0267-01,NDC,facility,inpatient,1,EA,,2.12,1.27,1.74,2.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lamoTRIgine 25 mg Tab [MDH],70375,CDM,,,0637,RC,51672-0413-01,NDC,facility,inpatient,1,EA,,2.13,1.28,1.75,2.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 40 mg Tab,74555,CDM,,,0637,RC,69315-0117-01,NDC,facility,inpatient,1,EA,,2.14,1.28,1.75,2.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE SA-65-H   2-0 SILK BLK,3129503,CDM,,,0272,RC,,,facility,inpatient,,,,2.15,1.29,1.76,2.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab,70815,CDM,,,0637,RC,60687-0627-01,NDC,facility,inpatient,1,EA,,2.15,1.29,1.76,2.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ferrous sulfate (as elemental iron) 45 mg Tab,71518,CDM,,,0637,RC,00536-3481-08,NDC,facility,inpatient,1,EA,,2.15,1.29,1.76,2.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prochlorperazine 5 mg Tab [MDH],71955,CDM,,,0636,RC,51079-0541-20,NDC,facility,inpatient,1,EA,,2.15,1.29,1.76,2.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide 12.5 mg Tab [MDH],72275,CDM,,,0637,RC,69315-0155-01,NDC,facility,inpatient,1,EA,,2.15,1.29,1.76,2.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 40 mg Tab [MDH],74555,CDM,,,0637,RC,51079-0073-20,NDC,facility,inpatient,1,EA,,2.15,1.29,1.76,2.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq Tab,83529,CDM,,,0637,RC,60687-0756-09,NDC,facility,inpatient,1,EA,,2.15,1.29,1.76,2.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 10 mEq Tab,71474,CDM,,,0636,RC,00245-5317-01,NDC,facility,inpatient,1,EA,,2.16,1.3,1.77,2.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING MEPILEX 4X4,2291407,CDM,,,0270,RC,,,facility,inpatient,,,,2.17,1.3,1.78,2.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMAL SALINE .9%  250ML B,3019001,CDM,,,0270,RC,,,facility,inpatient,,,,2.17,1.3,1.78,2.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 10 mEq ER Tab [MDH],71474,CDM,,,0250,RC,00245-0057-89,NDC,facility,inpatient,1,EA,,2.17,1.3,1.78,2.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate sodium 100 mg Cap,71855,CDM,,,0637,RC,00904-6455-61,NDC,facility,inpatient,1,EA,,2.17,1.3,1.78,2.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 20 mg/5 mL Sol [MDH],72255,CDM,,,0637,RC,00054-3727-63,NDC,facility,inpatient,500,ML,,2.17,1.3,1.78,2.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traMADol 50 mg Tab,79066,CDM,,,0637,RC,60687-0795-01,NDC,facility,inpatient,1,EA,,2.17,1.3,1.78,2.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 30 mg Tab [MDH],71517,CDM,,,0637,RC,63739-0079-10,NDC,facility,inpatient,1,EA,,2.18,1.31,1.79,2.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amitriptyline 10 mg Tab [MDH],73040,CDM,,,0637,RC,00781-1486-01,NDC,facility,inpatient,1,EA,,2.18,1.31,1.79,2.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING MELGISORB 4 X 4,2091601,CDM,,,0270,RC,,,facility,inpatient,,,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING ALLEVYN 3X3 W/BORDER,2225902,CDM,A6212,CPT,0272,RC,,,facility,inpatient,,,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER LOFRIC 14FR 16,3208520,CDM,,,0272,RC,,,facility,inpatient,,,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium oxide 400 mg Tab [MDH],70327,CDM,,,0637,RC,63739-0354-10,NDC,facility,inpatient,1,EA,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
trihexyphenidyl 2 mg Tab [MDH],70720,CDM,,,0637,RC,00591-5335-01,NDC,facility,inpatient,1,EA,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 10 mg Tab [MDH],76705,CDM,,,0637,RC,54868-0109-03,NDC,facility,inpatient,1,EA,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate-senna 50 mg-8.6 mg Tab,76980,CDM,,,0637,RC,63739-0432-10,NDC,facility,inpatient,1,EA,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine pamoate 25 mg Cap [MDH],78575,CDM,,,0636,RC,00185-0613-01,NDC,facility,inpatient,1,EA,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine pamoate 25 mg Cap,78575,CDM,,,0636,RC,00185-0674-01,NDC,facility,inpatient,1,EA,,2.19,1.31,1.8,2.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lithium 150 mg Cap,71851,CDM,,,0637,RC,00054-8526-25,NDC,facility,inpatient,1,EA,,2.2,1.32,1.8,2.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glipiZIDE2.5 mg tab (1/2) [MDH],71865,CDM,,,0637,RC,51079-0810-01A,NDC,facility,inpatient,1,EA,,2.2,1.32,1.8,2.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.25 mg tab (1/2) [MDH],71868,CDM,,,0637,RC,68084-0736-11A,NDC,facility,inpatient,1,EA,,2.2,1.32,1.8,2.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carisoprodol 350 mg Tab [MDH],77225,CDM,,,0637,RC,68084-0380-01,NDC,facility,inpatient,1,EA,,2.2,1.32,1.8,2.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq Tab,83529,CDM,,,0637,RC,00245-5319-11,NDC,facility,inpatient,1,EA,,2.2,1.32,1.8,2.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq Tab,83529,CDM,,,0637,RC,68001-0567-00,NDC,facility,inpatient,1,EA,,2.2,1.32,1.8,2.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING SMALL LONG KNEE,2118507,CDM,,,0270,RC,,,facility,inpatient,,,,2.21,1.33,1.81,2.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
folic acid 1 mg Tab [MDH],73410,CDM,,,0637,RC,62584-0897-01,NDC,facility,inpatient,1,EA,,2.21,1.33,1.81,2.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING LARGE LONG KNEE A-E,2120503,CDM,,,0272,RC,,,facility,inpatient,,,,2.22,1.33,1.82,2.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 300 mg Cap,70208,CDM,,,0637,RC,00904-6666-61,NDC,facility,inpatient,1,EA,,2.22,1.33,1.82,2.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 1 mg Tab [MDH],76513,CDM,,,0636,RC,59746-0171-06,NDC,facility,inpatient,1,EA,,2.22,1.33,1.82,2.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
senna 8.6 mg Tab,76975,CDM,,,0637,RC,46122-0702-78,NDC,facility,inpatient,1,EA,,2.22,1.33,1.82,2.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 200 mg Tab [MDH],75889,CDM,,,0637,RC,00603-4886-21,NDC,facility,inpatient,1,EA,,2.23,1.34,1.83,2.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diazepam 5 mg Tab [MDH],78415,CDM,,,0637,RC,00172-3926-60,NDC,facility,inpatient,1,EA,,2.23,1.34,1.83,2.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ANTI-FUNGAL OINTMENT,2132904,CDM,,,0270,RC,,,facility,inpatient,,,,2.24,1.34,1.84,2.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 300 mg Cap,70208,CDM,,,0637,RC,63739-0236-10,NDC,facility,inpatient,1,EA,,2.24,1.34,1.84,2.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 0.5 mg Tab [MDH],72365,CDM,,,0637,RC,00054-8179-25,NDC,facility,inpatient,1,EA,,2.25,1.35,1.84,2.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 20 mg Tab [MDH],74557,CDM,,,0637,RC,51079-0072-19,NDC,facility,inpatient,1,EA,,2.25,1.35,1.84,2.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
senna 8.6 mg Tab [MDH],76975,CDM,,,0637,RC,67618-0300-10,NDC,facility,inpatient,1,EA,,2.25,1.35,1.84,2.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyanocobalamin 1000 mcg Tab,71483,CDM,,,0637,RC,77333-0938-10,NDC,facility,inpatient,1,EA,,2.26,1.36,1.85,2.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cholecalciferol 400 intl units/mL Liq 50 mL [MDH],71792,CDM,,,0637,RC,50383-0917-50,NDC,facility,inpatient,50,ML,,2.26,1.36,1.85,2.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING MEDIUM SHORT KNEE,2117025,CDM,,,0270,RC,,,facility,inpatient,,,,2.27,1.36,1.86,2.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloNIDine 0.1 mg Tab,71540,CDM,,,0637,RC,62332-0054-31,NDC,facility,inpatient,1,EA,,2.27,1.36,1.86,2.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin-witch hazel Top 10%-50% Pad [MDH],78237,CDM,,,0637,RC,50289-3250-01,NDC,facility,inpatient,1,EA,,2.27,1.36,1.86,2.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Magnesium Oxide and Pyridoxine Tab [MDH],71011,CDM,,,0637,RC,00486-1132-01,NDC,facility,inpatient,1,EA,,2.28,1.37,1.87,2.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.17,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VICRYL 2 CP 27 UNDYED,3172008,CDM,,,0272,RC,,,facility,inpatient,,,,2.29,1.37,1.88,2.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lamoTRIgine 25 mg Tab [MDH],70375,CDM,,,0637,RC,68084-0318-01,NDC,facility,inpatient,1,EA,,2.29,1.37,1.88,2.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clonazePAM 0.25mg tab (1/4) [MDH],71861,CDM,,,0637,RC,51079-0882-01A,NDC,facility,inpatient,1,EA,,2.29,1.37,1.88,2.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
APAP/butalbital/caffeine 325 mg-50 mg-40 mg Tab [MDH],73351,CDM,,,0637,RC,68084-0396-01,NDC,facility,inpatient,1,EA,,2.29,1.37,1.88,2.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
senna 8.6 mg Tab [MDH],76975,CDM,,,0637,RC,67618-0300-11,NDC,facility,inpatient,1,EA,,2.29,1.37,1.88,2.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gemfibrozil 600 mg Tab [MDH],70062,CDM,,,0637,RC,68084-0473-01,NDC,facility,inpatient,1,EA,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
spironolactone 25 mg Tab,70270,CDM,,,0637,RC,60687-0465-01,NDC,facility,inpatient,1,EA,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lamoTRIgine 100 mg Tab [MDH],70365,CDM,,,0250,RC,68084-0319-01,NDC,facility,inpatient,1,EA,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levETIRAcetam 500 mg Tab,71169,CDM,,,0637,RC,00904-7124-61,NDC,facility,inpatient,1,EA,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
folic acid 1 mg Tab,73410,CDM,,,0637,RC,11534-0165-01,NDC,facility,inpatient,1,EA,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thioridazine 10 mg Tab [MDH],75000,CDM,,,0637,RC,53489-0148-01,NDC,facility,inpatient,1,EA,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thiothixene 1 mg Cap [MDH],77026,CDM,,,0637,RC,00781-2226-01,NDC,facility,inpatient,1,EA,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 1 mg/mL Inj Sol 2mL [MDH],78510,CDM,,,0636,RC,00409-2305-21,NDC,facility,inpatient,2,ML,,2.3,1.38,1.89,2.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FILTER TRIPLE LUMEN SUMP DRAIIN,3176900,CDM,,,0272,RC,,,facility,inpatient,,,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ampicillin 250 mg Cap [MDH],70485,CDM,,,0637,RC,00781-2144-01,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrALAZINE 25 mg Tab,70605,CDM,,,0637,RC,60687-0822-01,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfaSALAzine 500 mg Tab [MDH],70920,CDM,,,0637,RC,00591-0796-01,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ferrous sulfate (as elemental iron) 45 mg Tab [MDH],71518,CDM,,,0637,RC,00067-4347-90,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloNIDine 0.1 mg Tab [MDH],71540,CDM,,,0637,RC,00904-5656-61,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloNIDine 0.1 mg Tab [MDH],71540,CDM,,,0637,RC,62584-0657-01,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 500 mg Tab,71826,CDM,,,0637,RC,00904-6861-61,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
simethicone 80 mg Tab,75340,CDM,,,0637,RC,77333-0812-10,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zinc sulfate 220 mg Cap,75885,CDM,,,0637,RC,77333-0983-10,NDC,facility,inpatient,1,EA,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zidovudine 50 mg/5 mL Oral Syrup [MDH],81787,CDM,,,0636,RC,65862-0048-24,NDC,facility,inpatient,240,ML,,2.31,1.39,1.89,2.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-603-H    0  VICRYL  U,3195306,CDM,,,0272,RC,,,facility,inpatient,,,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloNIDine 0.1 mg Tab,71540,CDM,,,0637,RC,29300-0135-01,NDC,facility,inpatient,1,EA,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloNIDine 0.1 mg Tab [MDH],71540,CDM,,,0637,RC,51079-0299-20,NDC,facility,inpatient,1,EA,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 250 mg Tab,72455,CDM,,,0637,RC,00904-6860-61,NDC,facility,inpatient,1,EA,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 400 mg Tab,75215,CDM,,,0637,RC,60687-0446-01,NDC,facility,inpatient,1,EA,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 400 mg Tab [MDH],75215,CDM,,,0637,RC,68084-0658-01,NDC,facility,inpatient,1,EA,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nitroglycerin 0.4 mg Tab,75680,CDM,,,0637,RC,59651-0658-04,NDC,facility,inpatient,1,EA,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 200 mg Tab [MDH],75889,CDM,,,0637,RC,00904-5154-60,NDC,facility,inpatient,1,EA,,2.32,1.39,1.9,2.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING EXU-DRY 6X9,5695616,CDM,,,0272,RC,,,facility,inpatient,,,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 25 mg Tab [MDH],70102,CDM,,,0637,RC,00378-0018-01,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 25 mg Tab [MDH],70102,CDM,,,0636,RC,51079-0255-20,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amoxicillin 250 mg Cap [MDH],70471,CDM,,,0637,RC,62584-0237-01,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrALAZINE 25 mg Tab [MDH],70605,CDM,,,0637,RC,62584-0733-01,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfaSALAzine 500 mg Tab [MDH],70920,CDM,,,0637,RC,59762-5000-01,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
omega-3 polyunsaturated fatty acids 1000 mg Cap,71351,CDM,,,0637,RC,77333-0308-10,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloNIDine 0.1 mg Tab,71540,CDM,,,0636,RC,68001-0237-00,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diazePAM 2 mg Tab [MDH],78410,CDM,,,0637,RC,51079-0284-20,NDC,facility,inpatient,1,EA,,2.33,1.4,1.91,2.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 10 mg Tab [MDH],71433,CDM,,,0637,RC,00904-5529-52,NDC,facility,inpatient,1,EA,,2.34,1.4,1.92,2.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 400 mg Cap,71552,CDM,,,0637,RC,00904-6667-61,NDC,facility,inpatient,1,EA,,2.34,1.4,1.92,2.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ciprofloxacin 250 mg Tab,71757,CDM,,,0637,RC,63739-0700-10,NDC,facility,inpatient,1,EA,,2.34,1.4,1.92,2.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 100 mg Chewable Tab [MDH],72329,CDM,,,0637,RC,50580-0932-01,NDC,facility,inpatient,1,EA,,2.34,1.4,1.92,2.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 0.75 mg Tab [MDH],72370,CDM,,,0637,RC,00054-4180-25,NDC,facility,inpatient,1,EA,,2.34,1.4,1.92,2.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 0.75 mg Tab [MDH],72370,CDM,,,0637,RC,00054-8180-25,NDC,facility,inpatient,1,EA,,2.34,1.4,1.92,2.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
digoxin 250 mcg (0.25 mg) Tab [MDH],74474,CDM,,,0637,RC,62584-0990-01,NDC,facility,inpatient,1,EA,,2.34,1.4,1.92,2.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,1.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  811-H    2-0 GUT CHR C,3155003,CDM,,,0272,RC,,,facility,inpatient,,,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE X-518-H    1  ETHIBOND,3259607,CDM,,,0272,RC,,,facility,inpatient,,,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 25 mg Tab [MDH],70102,CDM,,,0637,RC,57664-0506-52,NDC,facility,inpatient,1,EA,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amoxicillin 250 mg Cap,70471,CDM,,,0637,RC,00093-3107-01,NDC,facility,inpatient,1,EA,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amoxicillin 250 mg Cap [MDH],70471,CDM,,,0636,RC,00781-2020-01,NDC,facility,inpatient,1,EA,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amoxicillin 250 mg Cap,70471,CDM,,,0637,RC,65862-0016-01,NDC,facility,inpatient,1,EA,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 20 mg Tab [MDH],73960,CDM,,,0637,RC,51079-0278-20,NDC,facility,inpatient,1,EA,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium bicarbonate 25 mEq Tab [MDH],74430,CDM,,,0250,RC,51801-0001-30,NDC,facility,inpatient,1,EA,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zinc oxide topical 16% Oin [MDH],78705,CDM,,,0637,RC,62103-0333-00,NDC,facility,inpatient,30,GM,,2.35,1.41,1.93,2.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
folic acid 0.4 mg Tab,71422,CDM,,,0637,RC,50268-0346-15,NDC,facility,inpatient,1,EA,,2.36,1.42,1.94,2.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE 1.25 mg Tab [MDH],71438,CDM,,,0637,RC,00093-8342-01,NDC,facility,inpatient,1,EA,,2.36,1.42,1.94,2.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE 1.25 mg Tab,71438,CDM,,,0637,RC,00093-9477-53,NDC,facility,inpatient,1,EA,,2.36,1.42,1.94,2.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE 1.25 mg Tab [MDH],71438,CDM,,,0637,RC,23155-0056-01,NDC,facility,inpatient,1,EA,,2.36,1.42,1.94,2.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 250 mg Oral DR Tab [MDH],72455,CDM,,,0637,RC,68084-0314-01,NDC,facility,inpatient,1,EA,,2.36,1.42,1.94,2.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 600 mg ER Tab [MDH],71150,CDM,,,0637,RC,46122-0028-78,NDC,facility,inpatient,1,EA,,2.37,1.42,1.94,2.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
megestrol 40 mg Tab,74991,CDM,,,0637,RC,00904-7236-61,NDC,facility,inpatient,1,EA,,2.37,1.42,1.94,2.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
iron polysaccharide 150 mg Cap [MDH],75625,CDM,,,0637,RC,60258-0185-01,NDC,facility,inpatient,1,EA,,2.37,1.42,1.94,2.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 10 mg Tab,76775,CDM,,,0637,RC,00093-2203-01,NDC,facility,inpatient,1,EA,,2.37,1.42,1.94,2.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE SA-66-G    0  SILK BLK,3269002,CDM,,,0272,RC,,,facility,inpatient,,,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
heparin flush 10 units/mL Sol 3mL [MDH],70311,CDM,,,0636,RC,08881-5801-23,NDC,facility,inpatient,3,ML,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sertraline 100 mg Tab [MDH],75141,CDM,,,0637,RC,59762-4910-03,NDC,facility,inpatient,1,EA,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 10 mg Tab [MDH],76775,CDM,,,0637,RC,68084-0009-01,NDC,facility,inpatient,1,EA,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zidovudine 50 mg/5 mL Oral Syrup [MDH],81787,CDM,,,0636,RC,49702-0212-48,NDC,facility,inpatient,240,ML,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq ER Tab [MDH],83529,CDM,,,0637,RC,00245-0058-89,NDC,facility,inpatient,1,EA,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq Tab,83529,CDM,,,0637,RC,00245-5319-01,NDC,facility,inpatient,1,EA,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq ER Tab [MDH],83529,CDM,,,0637,RC,66758-0190-13,NDC,facility,inpatient,1,EA,,2.38,1.43,1.95,2.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Prenatal Multivitamins with Folic Acid 1 mg Tab [MDH],75626,CDM,,,0637,RC,13811-0007-10,NDC,facility,inpatient,1,EA,,2.39,1.43,1.96,2.39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.39,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lactobacillus acidophilus Tab [MDH],70940,CDM,,,0637,RC,64980-0164-01,NDC,facility,inpatient,1,EA,,2.4,1.44,1.97,2.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.28,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine hydrochloride 10 mg Tab [MDH],70810,CDM,,,0637,RC,68084-0253-01,NDC,facility,inpatient,1,EA,,2.41,1.45,1.98,2.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 800 mg-160 mg Tab [MDH],78046,CDM,,,0637,RC,68084-0230-01,NDC,facility,inpatient,1,EA,,2.41,1.45,1.98,2.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methocarbamol 500 mg Tab UD [MDH],72257,CDM,,,0637,RC,60687-0559-01,NDC,facility,inpatient,1,EA,,2.42,1.45,1.98,2.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin adult Supp [MDH],73645,CDM,,,0637,RC,00132-0079-50,NDC,facility,inpatient,1,EA,,2.42,1.45,1.98,2.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHAMPOO - BODY NO RINSE,2130007,CDM,,,0270,RC,,,facility,inpatient,,,,2.43,1.46,1.99,2.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMAL SALINE .9%  500ML BAG,3018508,CDM,,,0270,RC,,,facility,inpatient,,,,2.43,1.46,1.99,2.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 600 mg Tab,75216,CDM,,,0637,RC,00904-5854-61,NDC,facility,inpatient,1,EA,,2.43,1.46,1.99,2.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",1.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CONVAFOAM ADH SIL 10X10CM,5697313,CDM,,,0270,RC,,,facility,inpatient,,,,2.44,1.46,2,2.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cimetidine 200 mg Tab [MDH],71605,CDM,,,0637,RC,00135-0148-05,NDC,facility,inpatient,1,EA,,2.44,1.46,2,2.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isoniazid 300 mg Tab [MDH],74075,CDM,,,0637,RC,00555-0071-02,NDC,facility,inpatient,1,EA,,2.44,1.46,2,2.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
quiNIDine 200 mg Tab [MDH],76752,CDM,,,0637,RC,00185-4346-01,NDC,facility,inpatient,1,EA,,2.44,1.46,2,2.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 80 mg Tab,78507,CDM,,,0637,RC,23155-0026-01,NDC,facility,inpatient,1,EA,,2.44,1.46,2,2.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 25 mg Tab *,70064,CDM,,,0637,RC,60687-0605-01,NDC,facility,inpatient,1,EA,,2.45,1.47,2.01,2.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
multivitamin Pediatric Multiple Vitamins Liq [MDH],76410,CDM,,,0637,RC,00087-0402-03,NDC,facility,inpatient,50,ML,,2.45,1.47,2.01,2.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
multivitamin with iron Pediatric Multiple Vitamins with Iron Liq [MDH],76415,CDM,,,0637,RC,00087-0405-01,NDC,facility,inpatient,50,ML,,2.45,1.47,2.01,2.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 2.5 mg Tab [MDH],77054,CDM,,,0637,RC,00555-0872-02,NDC,facility,inpatient,1,EA,,2.45,1.47,2.01,2.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 2.5 mg Tab,77054,CDM,,,0637,RC,59762-3740-01,NDC,facility,inpatient,1,EA,,2.45,1.47,2.01,2.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
QUICK CATCH IN-LINE SUCTION POLYP TRAP,2598702,CDM,,,0272,RC,,,facility,inpatient,,,,2.46,1.48,2.02,2.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CHROMIC GUT 3-0 SH 27 BROWN,3136003,CDM,,,0272,RC,,,facility,inpatient,,,,2.46,1.48,2.02,2.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atorvastatin 5 mg tab (1/2) [MDH],71947,CDM,,,0250,RC,68084-0097-11A,NDC,facility,inpatient,1,EA,,2.46,1.48,2.02,2.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
salsalate 750 mg Tab [MDH],72761,CDM,,,0637,RC,57664-0105-08,NDC,facility,inpatient,1,EA,,2.46,1.48,2.02,2.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amitriptyline 10 mg Tab,73040,CDM,,,0637,RC,16729-0171-01,NDC,facility,inpatient,1,EA,,2.46,1.48,2.02,2.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amitriptyline 10 mg Tab *,73040,CDM,,,0637,RC,29300-0419-01,NDC,facility,inpatient,1,EA,,2.46,1.48,2.02,2.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amitriptyline 10 mg Tab [MDH],73040,CDM,,,0637,RC,51079-0131-20,NDC,facility,inpatient,1,EA,,2.46,1.48,2.02,2.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  663-G    3-0 ETHILON F,3147000,CDM,,,0272,RC,,,facility,inpatient,,,,2.47,1.48,2.03,2.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methadone 5 mg Tab [MDH],46470,CDM,,,0637,RC,00406-5755-01,NDC,facility,inpatient,1,EA,,2.47,1.48,2.03,2.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lactobacillus acidophilus Tab [MDH],70940,CDM,,,0637,RC,63736-0105-06,NDC,facility,inpatient,1,EA,,2.47,1.48,2.03,2.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diazePAM 5 mg Tab [MDH],78415,CDM,,,0637,RC,00904-5880-61,NDC,facility,inpatient,1,EA,,2.47,1.48,2.03,2.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diazePAM 5 mg Tab,78415,CDM,,,0250,RC,51079-0285-20,NDC,facility,inpatient,1,EA,,2.47,1.48,2.03,2.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-codeine 300 mg-30 mg Tab [MDH],46820,CDM,,,0637,RC,51079-0161-20,NDC,facility,inpatient,1,EA,,2.48,1.49,2.03,2.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meclizine 12.5 mg Tab,70555,CDM,,,0637,RC,68001-0528-00,NDC,facility,inpatient,1,EA,,2.48,1.49,2.03,2.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
heparin flush 500 units/5 mL (100 units/mL) Sol 5 mL syringe [MDH],71531,CDM,,,0636,RC,08290-3065-13,NDC,facility,inpatient,5,ML,,2.49,1.49,2.04,2.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHARPS CONTAINER WALL MOUNT 5QT REFILL,2083202,CDM,,,0270,RC,,,facility,inpatient,,,,2.5,1.5,2.05,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT -SILVER SNEAKERS,51900,CDM,,,0420,RC,,,facility,inpatient,,,,2.5,1.5,2.05,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg Tab [MDH],70007,CDM,,,0637,RC,00093-2204-01,NDC,facility,inpatient,1,EA,,2.5,1.5,2.05,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab [MDH],70815,CDM,,,0637,RC,51079-0417-21,NDC,facility,inpatient,1,EA,,2.5,1.5,2.05,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-oxyCODONE 325 mg-5 mg Tab [MDH],71508,CDM,,,0636,RC,00904-7093-61,NDC,facility,inpatient,1,EA,,2.5,1.5,2.05,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium bicarbonate 25 mEq Tab,74430,CDM,,,0637,RC,00904-2720-46,NDC,facility,inpatient,1,EA,,2.5,1.5,2.05,2.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BAG DRAIN URINARY LEG MED,2028207,CDM,A4358,CPT,0272,RC,,,facility,inpatient,,,,2.51,1.51,2.06,2.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE G-121-H   4-0 GUT CHR,3223009,CDM,,,0272,RC,,,facility,inpatient,,,,2.51,1.51,2.06,2.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 100 mg Cap,72650,CDM,,,0637,RC,57664-0808-88,NDC,facility,inpatient,1,EA,,2.51,1.51,2.06,2.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE U202H CHROMIC SIZE 5-0,1329414,CDM,,,0272,RC,,,facility,inpatient,,,,2.52,1.51,2.07,2.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE JB-259   2-0 VICRYL,2479400,CDM,,,0272,RC,,,facility,inpatient,,,,2.52,1.51,2.07,2.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LIGACLIP LIGATING CLIPS MEDIUM,3173215,CDM,,,0272,RC,,,facility,inpatient,,,,2.52,1.51,2.07,2.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 10 mEq Tab,71474,CDM,,,0636,RC,60687-0632-01,NDC,facility,inpatient,1,EA,,2.52,1.51,2.07,2.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  813-H     1  GUT CHR C,3157009,CDM,,,0272,RC,,,facility,inpatient,,,,2.53,1.52,2.07,2.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE Z-317-H   2-0 PDS,3215708,CDM,,,0272,RC,,,facility,inpatient,,,,2.53,1.52,2.07,2.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE G-124-H    0  GUT CHR,3257007,CDM,,,0272,RC,,,facility,inpatient,,,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ezetimibe 10 mg Tab [MDH],70123,CDM,,,0637,RC,00781-5690-31,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
QUEtiapine 25 mg Tab,71033,CDM,,,0637,RC,00904-6638-61,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loratadine 5 mg tab (1/2) [MDH],71867,CDM,,,0637,RC,68084-0248-11A,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN250 mg tab (1/2) [MDH],71873,CDM,,,0637,RC,62584-0259-11A,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Allopurinol 150 mg (1/2) [MDH] 150 mg Tab,71999,CDM,,,0637,RC,62584-0713-11A,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 160 mg Chewable Tab  [MDH],72328,CDM,,,0637,RC,46122-0424-62,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 10 mg Tab [MDH],73955,CDM,,,0637,RC,00904-6550-61,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium bicarbonate 25 mEq Eff Tab [MDH],74430,CDM,,,0637,RC,50201-2400-02,NDC,facility,inpatient,1,EA,,2.54,1.52,2.08,2.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  661-H    5-0 ETHILON F,3145004,CDM,,,0272,RC,,,facility,inpatient,,,,2.55,1.53,2.09,2.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  812-H     0  GUT CHR C,3156001,CDM,,,0272,RC,,,facility,inpatient,,,,2.55,1.53,2.09,2.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyanocobalamin 1000 mcg Tab [MDH],71483,CDM,,,0637,RC,50268-0855-15,NDC,facility,inpatient,1,EA,,2.55,1.53,2.09,2.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlordiazePOXIDE 5 mg Cap,74585,CDM,,,0637,RC,00555-0158-02,NDC,facility,inpatient,1,EA,,2.55,1.53,2.09,2.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thioridazine 25 mg Tab [MDH],75010,CDM,,,0637,RC,53489-0149-01,NDC,facility,inpatient,1,EA,,2.55,1.53,2.09,2.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE U-203-H   4-0 CHROMIC,2060002,CDM,,,0272,RC,,,facility,inpatient,,,,2.56,1.54,2.1,2.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
folic acid 1 mg Tab [MDH],73410,CDM,,,0637,RC,00591-5216-01,NDC,facility,inpatient,1,EA,,2.56,1.54,2.1,2.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-codeine 300 mg-30 mg Tab [MDH],46820,CDM,,,0636,RC,00406-0484-62,NDC,facility,inpatient,1,EA,,2.57,1.54,2.11,2.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amitriptyline 25 mg Tab [MDH],73045,CDM,,,0637,RC,00781-1487-01,NDC,facility,inpatient,1,EA,,2.57,1.54,2.11,2.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glipiZIDE 5 mg Tab,73633,CDM,,,0637,RC,60505-0141-00,NDC,facility,inpatient,1,EA,,2.57,1.54,2.11,2.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 600 mg Tab,75216,CDM,,,0636,RC,60687-0457-01,NDC,facility,inpatient,1,EA,,2.57,1.54,2.11,2.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 600 mg Tab [MDH],75216,CDM,,,0637,RC,68084-0703-01,NDC,facility,inpatient,1,EA,,2.57,1.54,2.11,2.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PUTTY HAND THERAPY GREEN/MED,2159600,CDM,,,0270,RC,,,facility,inpatient,,,,2.58,1.55,2.12,2.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FOAM LITE 3.9 X 3.9,5693212,CDM,,,0272,RC,,,facility,inpatient,,,,2.58,1.55,2.12,2.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diclofenac sodium 75 mg Oral EC Tab [MDH],70060,CDM,,,0637,RC,51079-0224-01,NDC,facility,inpatient,1,EA,,2.58,1.55,2.12,2.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methyldopa 250 mg Tab [MDH],70290,CDM,,,0637,RC,51079-0200-20,NDC,facility,inpatient,1,EA,,2.58,1.55,2.12,2.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 400 mg Tab,75215,CDM,,,0637,RC,67877-0319-01,NDC,facility,inpatient,1,EA,,2.58,1.55,2.12,2.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 400 mg-80 mg Tab,78041,CDM,,,0637,RC,60687-0603-65,NDC,facility,inpatient,1,EA,,2.58,1.55,2.12,2.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab,78657,CDM,,,0637,RC,60687-0377-01,NDC,facility,inpatient,1,EA,,2.58,1.55,2.12,2.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  627-H    3-0 ETHILON,3214701,CDM,,,0272,RC,,,facility,inpatient,,,,2.59,1.55,2.12,2.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 1 mg/mL Inj Sol 2mL [MDH],78510,CDM,,,0636,RC,00409-2305-49,NDC,facility,inpatient,2,ML,,2.59,1.55,2.12,2.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PUTTY HAND THERAPY RED/MED SOF,2159006,CDM,,,0272,RC,,,facility,inpatient,,,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PUTTY HAND THERAPY YELLOW/SOFT,2159501,CDM,,,0270,RC,,,facility,inpatient,,,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMAL SALINE .9% 1000ML B,3018003,CDM,,,0270,RC,,,facility,inpatient,,,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8623-H  2-0 PROLENE  KS,3103307,CDM,,,0272,RC,,,facility,inpatient,,,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
AQUACEL EXTRA 4X5,5697818,CDM,,,0270,RC,,,facility,inpatient,,,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab [MDH],70815,CDM,,,0637,RC,68084-0736-01,NDC,facility,inpatient,1,EA,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cholecalciferol 5000 intl units Cap UD [MDH],72154,CDM,,,0637,RC,50268-0868-15,NDC,facility,inpatient,1,EA,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glipiZIDE 5 mg Tab [MDH],73633,CDM,,,0637,RC,51079-0810-20,NDC,facility,inpatient,1,EA,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 800 mg-160 mg Tab,78046,CDM,,,0637,RC,00904-2725-61,NDC,facility,inpatient,1,EA,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
allopurinol 100 mg Tab [MDH],78710,CDM,,,0637,RC,51079-0205-20,NDC,facility,inpatient,1,EA,,2.6,1.56,2.13,2.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL LACT RINGERS INJ 1000ML,3013509,CDM,,,0270,RC,,,facility,inpatient,,,,2.61,1.57,2.14,2.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUCTION BULB RESERVOIR JACKSON PRATT 100CC SILICONE,3155215,CDM,,,0272,RC,,,facility,inpatient,,,,2.61,1.57,2.14,2.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  922-H    3-0 GUT CHR C,3166000,CDM,,,0272,RC,,,facility,inpatient,,,,2.61,1.57,2.14,2.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sucralfate 1 g Tab [MDH],71498,CDM,,,0637,RC,51079-0753-20,NDC,facility,inpatient,1,EA,,2.61,1.57,2.14,2.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
indomethacin 25 mg Cap [MDH],73980,CDM,,,0637,RC,31722-0542-01,NDC,facility,inpatient,1,EA,,2.61,1.57,2.14,2.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE VCP662H VICRYL 4.0 STRAIGHT,2059920,CDM,,,0272,RC,,,facility,inpatient,,,,2.62,1.57,2.15,2.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone2.5mgtab (1/2) [MDH],71859,CDM,,,0637,RC,51079-0985-01A,NDC,facility,inpatient,1,EA,,2.62,1.57,2.15,2.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clonazePAM 0.5 mg Tab [MDH],72082,CDM,,,0636,RC,00228-3003-11,NDC,facility,inpatient,1,EA,,2.62,1.57,2.15,2.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clonazePAM 0.5 mg Tab,72082,CDM,,,0636,RC,16729-0136-00,NDC,facility,inpatient,1,EA,,2.62,1.57,2.15,2.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clonazePAM 0.5 mg Tab,72082,CDM,,,0636,RC,43547-0406-10,NDC,facility,inpatient,1,EA,,2.62,1.57,2.15,2.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clonazePAM 0.5 mg Tab,72082,CDM,,,0636,RC,72888-0152-01,NDC,facility,inpatient,1,EA,,2.62,1.57,2.15,2.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
benztropine 0.5 mg Tab,71536,CDM,,,0637,RC,00603-2437-21,NDC,facility,inpatient,1,EA,,2.63,1.58,2.16,2.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methocarbamol 750 mg Tab,76820,CDM,,,0637,RC,00904-7058-61,NDC,facility,inpatient,1,EA,,2.63,1.58,2.16,2.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL SOD CHL .45% 1000ML BAG,3019506,CDM,,,0270,RC,,,facility,inpatient,,,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab [MDH],72940,CDM,,,0637,RC,00378-1352-01,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab [MDH],72940,CDM,,,0637,RC,00781-1123-01,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab,72940,CDM,,,0637,RC,60505-2656-01,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab [MDH],72940,CDM,,,0637,RC,68001-0216-00,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab [MDH],72940,CDM,,,0637,RC,68001-0327-00,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab,72940,CDM,,,0637,RC,68001-0387-00,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylPREDNISolone 4 mg Tab [MDH],74955,CDM,,,0636,RC,00009-0056-04,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 400 mg Tab [MDH],75215,CDM,,,0637,RC,53746-0464-01,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 400 mg Tab,75215,CDM,,,0636,RC,65162-0464-10,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dipyridamole 25 mg Tab [MDH],76200,CDM,,,0637,RC,00904-1086-61,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 80 mg Tab [MDH],78507,CDM,,,0637,RC,00378-0512-01,NDC,facility,inpatient,1,EA,,2.64,1.58,2.16,2.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
J SHAPED CANNULA 27G X 22MM,3138515,CDM,,,0272,RC,,,facility,inpatient,,,,2.65,1.59,2.17,2.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine hydrochloride 25 mg Tab,70811,CDM,,,0637,RC,60687-0675-01,NDC,facility,inpatient,1,EA,,2.65,1.59,2.17,2.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine hydrochloride 25 mg Tab [MDH],70811,CDM,,,0636,RC,68084-0254-01,NDC,facility,inpatient,1,EA,,2.65,1.59,2.17,2.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 2.5 mg Tab,71429,CDM,,,0637,RC,60687-0285-01,NDC,facility,inpatient,1,EA,,2.65,1.59,2.17,2.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glimepiride 1 mg Tab [MDH],71436,CDM,,,0637,RC,68001-0177-00,NDC,facility,inpatient,1,EA,,2.65,1.59,2.17,2.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 5 mg Tab,75234,CDM,,,0637,RC,60687-0263-01,NDC,facility,inpatient,1,EA,,2.65,1.59,2.17,2.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 5 mg Tab [MDH],75234,CDM,,,0637,RC,68084-0259-01,NDC,facility,inpatient,1,EA,,2.65,1.59,2.17,2.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE 10% INJ  500ML BA,3008004,CDM,,,0272,RC,,,facility,inpatient,,,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  635-H    4-0 GUT CHR E,3214800,CDM,,,0272,RC,,,facility,inpatient,,,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aminophylline 25 mg/mL IV Sol - 10mL [MDH],70420,CDM,,,0636,RC,00517-3810-25,NDC,facility,inpatient,10,ML,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meclizine 25 mg Tab,70560,CDM,,,0637,RC,16571-0661-01,NDC,facility,inpatient,1,EA,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glimepiride 1 mg Tab,71436,CDM,,,0637,RC,16571-0773-01,NDC,facility,inpatient,1,EA,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glimepiride 1 mg Tab [MDH],71436,CDM,,,0637,RC,55111-0320-01,NDC,facility,inpatient,1,EA,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 12.5mg tab (1/2) [MDH],71857,CDM,,,0637,RC,51079-0759-01A,NDC,facility,inpatient,1,EA,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
indomethacin 25 mg Cap [MDH],73980,CDM,,,0637,RC,51079-0190-20,NDC,facility,inpatient,1,EA,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
indomethacin 25 mg Cap,73980,CDM,,,0637,RC,68462-0406-01,NDC,facility,inpatient,1,EA,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 800 mg Tab [MDH],75217,CDM,,,0636,RC,00904-5855-61,NDC,facility,inpatient,1,EA,,2.66,1.6,2.18,2.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg Tab [MDH],70007,CDM,,,0637,RC,51079-0629-20,NDC,facility,inpatient,1,EA,,2.67,1.6,2.19,2.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sertraline 25 mg Tab [MDH],71414,CDM,,,0250,RC,68084-0180-01,NDC,facility,inpatient,1,EA,,2.67,1.6,2.19,2.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ampicillin 500 mg Cap [MDH],74044,CDM,,,0637,RC,67253-0181-10,NDC,facility,inpatient,1,EA,,2.67,1.6,2.19,2.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 10 mg Cap [MDH],75982,CDM,,,0637,RC,00591-5786-01,NDC,facility,inpatient,1,EA,,2.67,1.6,2.19,2.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glipiZIDE 2.5 mg Tab,71115,CDM,,,0637,RC,64980-0279-03,NDC,facility,inpatient,1,EA,,2.68,1.61,2.2,2.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bumetanide 1 mg Tab [MDH],71379,CDM,,,0250,RC,51079-0892-20,NDC,facility,inpatient,1,EA,,2.68,1.61,2.2,2.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 12.5mg-50mg tab (1/2) [MDH],71860,CDM,,,0637,RC,68084-0093-11A,NDC,facility,inpatient,1,EA,,2.68,1.61,2.2,2.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 10 mg Tab [MDH],73955,CDM,,,0637,RC,00591-5554-01,NDC,facility,inpatient,1,EA,,2.68,1.61,2.2,2.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 10 mg Tab,73955,CDM,,,0637,RC,00603-5482-21,NDC,facility,inpatient,1,EA,,2.68,1.61,2.2,2.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 10 mg Tab [MDH],73955,CDM,,,0637,RC,23155-0110-01,NDC,facility,inpatient,1,EA,,2.68,1.61,2.2,2.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 10 mg Tab,73955,CDM,,,0637,RC,69238-2077-01,NDC,facility,inpatient,1,EA,,2.68,1.61,2.2,2.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrALAZINE 10 mg Tab [MDH],70600,CDM,,,0250,RC,50111-0398-01,NDC,facility,inpatient,1,EA,,2.69,1.61,2.21,2.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg Tab [MDH],70007,CDM,,,0637,RC,63739-0481-10,NDC,facility,inpatient,1,EA,,2.7,1.62,2.21,2.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin pediatric Sup,73640,CDM,,,0637,RC,58980-0409-12,NDC,facility,inpatient,1,EA,,2.7,1.62,2.21,2.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 10 mg Tab [MDH],76579,CDM,,,0637,RC,68084-0197-01,NDC,facility,inpatient,1,EA,,2.7,1.62,2.21,2.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  636-H    3-0 GUT CHR F,3227000,CDM,,,0272,RC,,,facility,inpatient,,,,2.71,1.63,2.22,2.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pseudoephedrine 120 mg ER Tab [MDH],77357,CDM,,,0637,RC,00081-0670-13,NDC,facility,inpatient,1,EA,,2.71,1.63,2.22,2.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-hydrocodone 325 mg-5 mg Tab,70138,CDM,,,0250,RC,00904-6567-61,NDC,facility,inpatient,1,EA,,2.72,1.63,2.23,2.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyproheptadine 4 mg Tab [MDH],76150,CDM,,,0637,RC,00093-2929-01,NDC,facility,inpatient,1,EA,,2.72,1.63,2.23,2.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
K-WIRE .063 X 9,3285212,CDM,,,0278,RC,,,facility,inpatient,,,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
spironolactone 25 mg Tab,70270,CDM,,,0637,RC,51079-0103-20,NDC,facility,inpatient,1,EA,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
indomethacin 25 mg Cap,73980,CDM,,,0637,RC,50268-0430-15,NDC,facility,inpatient,1,EA,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlordiazePOXIDE 25 mg Cap [MDH],74595,CDM,,,0637,RC,00555-0159-02,NDC,facility,inpatient,1,EA,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 800 mg Tab,75217,CDM,,,0637,RC,60687-0468-01,NDC,facility,inpatient,1,EA,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 800 mg Tab [MDH],75217,CDM,,,0636,RC,68084-0772-01,NDC,facility,inpatient,1,EA,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
imipramine 10 mg Tab [MDH],78065,CDM,,,0637,RC,00781-1762-01,NDC,facility,inpatient,1,EA,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
imipramine 10 mg Tab [MDH],78065,CDM,,,0637,RC,49884-0054-01,NDC,facility,inpatient,1,EA,,2.73,1.64,2.24,2.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amoxicillin 500 mg Cap [MDH],70472,CDM,,,0637,RC,00781-2613-01,NDC,facility,inpatient,1,EA,,2.74,1.64,2.25,2.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traZODone 50 mg Tab [MDH],72502,CDM,,,0637,RC,00904-3990-61,NDC,facility,inpatient,1,EA,,2.74,1.64,2.25,2.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traZODone 50 mg Tab [MDH],72502,CDM,,,0637,RC,00904-6554-61,NDC,facility,inpatient,1,EA,,2.74,1.64,2.25,2.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 250 mg Tab,73355,CDM,,,0637,RC,29300-0226-01,NDC,facility,inpatient,1,EA,,2.74,1.64,2.25,2.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 250 mg Tab [MDH],73355,CDM,,,0637,RC,50111-0333-01,NDC,facility,inpatient,1,EA,,2.74,1.64,2.25,2.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 120 mg/24 hours ERCap [MDH],75241,CDM,,,0637,RC,60687-0195-01,NDC,facility,inpatient,1,EA,,2.74,1.64,2.25,2.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 120 mg/24 hours ERCap [MDH],75241,CDM,,,0637,RC,68084-0052-01,NDC,facility,inpatient,1,EA,,2.74,1.64,2.25,2.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE PDS II 5-0 FS-2 CLEAR 27,3213915,CDM,,,0272,RC,,,facility,inpatient,,,,2.75,1.65,2.26,2.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE S-114-H    0  GUT CHR,3222506,CDM,,,0272,RC,,,facility,inpatient,,,,2.75,1.65,2.26,2.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxyBUTYnin 5 mg Tab,72765,CDM,,,0637,RC,69315-0182-01,NDC,facility,inpatient,1,EA,,2.75,1.65,2.26,2.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 25 mg-250 mg Tab,77070,CDM,,,0637,RC,60687-0836-01,NDC,facility,inpatient,1,EA,,2.75,1.65,2.26,2.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 25 mcg (0.025 mg) Tab,77535,CDM,,,0637,RC,69238-1830-01,NDC,facility,inpatient,1,EA,,2.75,1.65,2.26,2.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXT. 5% SALINE 1000ML BAG,3005505,CDM,,,0270,RC,,,facility,inpatient,,,,2.76,1.66,2.26,2.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NEEDLE ANCHOR SURG #1824-3DC,3112000,CDM,C1713,CPT,0278,RC,,,facility,inpatient,,,,2.76,1.66,2.26,2.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8833-H    2-0 PROLENE,3266503,CDM,,,0272,RC,,,facility,inpatient,,,,2.76,1.66,2.26,2.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.5 mg Tab,71808,CDM,,,0637,RC,60687-0388-01,NDC,facility,inpatient,1,EA,,2.76,1.66,2.26,2.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 10 mg Cap [MDH],75982,CDM,,,0637,RC,68084-0031-01,NDC,facility,inpatient,1,EA,,2.76,1.66,2.26,2.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Pediatric Multiple Vitamins Oral Liq 50 mL [MDH],76410,CDM,,,0637,RC,50383-0625-50,NDC,facility,inpatient,50,ML,,2.76,1.66,2.26,2.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glipiZIDE 5 mg Tab,73633,CDM,,,0637,RC,50268-0361-15,NDC,facility,inpatient,1,EA,,2.77,1.66,2.27,2.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 25 mcg (0.025 mg) Tab [MDH],77535,CDM,,,0637,RC,00527-1341-01,NDC,facility,inpatient,1,EA,,2.77,1.66,2.27,2.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methimazole 5 mg Tab [MDH],77625,CDM,,,0637,RC,49884-0640-01,NDC,facility,inpatient,1,EA,,2.77,1.66,2.27,2.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methIMAzole 5 mg Tab,77625,CDM,,,0637,RC,64380-0212-01,NDC,facility,inpatient,1,EA,,2.77,1.66,2.27,2.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL SOD CHL .45%  500ML BAG,3020009,CDM,,,0272,RC,,,facility,inpatient,,,,2.78,1.67,2.28,2.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE G-123-H   2-0 GUT CHR,3137001,CDM,,,0272,RC,,,facility,inpatient,,,,2.78,1.67,2.28,2.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE MONOCRYL 3-0 KS NEEDLE STR UNDYED 27,3249424,CDM,,,0272,RC,,,facility,inpatient,,,,2.78,1.67,2.28,2.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pantoprazole 40 mg Oral EC Tab [MDH],71044,CDM,,,0250,RC,66993-0068-80,NDC,facility,inpatient,1,EA,,2.78,1.67,2.28,2.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 30 mg Tab [MDH],71517,CDM,,,0637,RC,51079-0745-20,NDC,facility,inpatient,1,EA,,2.78,1.67,2.28,2.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 1 mg Tab [MDH],73690,CDM,,,0637,RC,00781-1392-13,NDC,facility,inpatient,1,EA,,2.79,1.67,2.29,2.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PHENobarbital 32.4 mg Tab,76320,CDM,,,0637,RC,00904-6575-61,NDC,facility,inpatient,1,EA,,2.79,1.67,2.29,2.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide mononitrate 30 mg Tab,70231,CDM,,,0637,RC,60687-0783-01,NDC,facility,inpatient,1,EA,,2.8,1.68,2.3,2.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
spironolactone 25 mg Tab [MDH],70270,CDM,,,0637,RC,00378-2146-01,NDC,facility,inpatient,1,EA,,2.8,1.68,2.3,2.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pantoprazole 40 mg Tab,71044,CDM,,,0250,RC,68084-0813-09,NDC,facility,inpatient,1,EA,,2.8,1.68,2.3,2.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sucralfate 1 g Tab,71498,CDM,,,0637,RC,60687-0695-01,NDC,facility,inpatient,1,EA,,2.8,1.68,2.3,2.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Penicillin V Potassium 250 mg Tab [MDH],74563,CDM,,,0637,RC,67253-0200-10,NDC,facility,inpatient,1,EA,,2.8,1.68,2.3,2.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 150 mcg (0.15 mg) Tab [MDH],77540,CDM,,,0637,RC,51079-0445-01,NDC,facility,inpatient,1,EA,,2.8,1.68,2.3,2.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq Tab,83529,CDM,,,0637,RC,68084-0360-09,NDC,facility,inpatient,1,EA,,2.8,1.68,2.3,2.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BAG DRAINAGE URINARY 2000ML,2028003,CDM,,,0272,RC,,,facility,inpatient,,,,2.81,1.69,2.3,2.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  832-H    3-0 GUT CHR C,3160003,CDM,,,0272,RC,,,facility,inpatient,,,,2.81,1.69,2.3,2.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methadone 5 mg Tab [MDH],46470,CDM,,,0637,RC,00406-5755-62,NDC,facility,inpatient,1,EA,,2.81,1.69,2.3,2.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
irbesartan 150 mg Tab,70363,CDM,,,0637,RC,00955-1041-90,NDC,facility,inpatient,1,EA,,2.81,1.69,2.3,2.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin pediatric Sup,73640,CDM,,,0637,RC,00132-0081-12,NDC,facility,inpatient,1,EA,,2.81,1.69,2.3,2.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 1 mg Tab,73690,CDM,,,0637,RC,00378-0257-01,NDC,facility,inpatient,1,EA,,2.81,1.69,2.3,2.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER TIEMANN 14FR PVC NON-LATEX RUSCH,2067310,CDM,,,0272,RC,,,facility,inpatient,,,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER TIEMANN 16FR PVC NON-LATEX RUSCH,2067315,CDM,,,0272,RC,,,facility,inpatient,,,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER TIEMANN 18FR PVC NON-LATEX RUSCH,2067320,CDM,,,0272,RC,,,facility,inpatient,,,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER TIEMANN 20FR PVC NON-LATEX RUSCH,2067325,CDM,,,0272,RC,,,facility,inpatient,,,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER TIEMANN 22FR PVC NON-LATEX RUSCH,2067330,CDM,,,0272,RC,,,facility,inpatient,,,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER TIEMANN 24FR PVC NON-LATEX RUSCH,2067335,CDM,,,0272,RC,,,facility,inpatient,,,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 20 mg Tab,70135,CDM,,,0637,RC,00904-7283-61,NDC,facility,inpatient,1,EA,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
primidone 50 mg Tab [MDH],71166,CDM,,,0637,RC,00603-5371-21,NDC,facility,inpatient,1,EA,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sertraline 25 mg Tab [MDH],71414,CDM,,,0637,RC,60687-0231-01,NDC,facility,inpatient,1,EA,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
baclofen 10 mg Tab [MDH],74645,CDM,,,0637,RC,00904-3365-61,NDC,facility,inpatient,1,EA,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dilTIAZem 180 mg/24 hours Cap,75203,CDM,,,0637,RC,00904-7218-61,NDC,facility,inpatient,1,EA,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methocarbamol 750 mg Tab [MDH],76820,CDM,,,0637,RC,00143-1292-01,NDC,facility,inpatient,1,EA,,2.82,1.69,2.31,2.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nitroglycerin 0.4 mg Tab,75680,CDM,,,0637,RC,68462-0639-01,NDC,facility,inpatient,1,EA,,2.83,1.7,2.32,2.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 25 mcg (0.025 mg) Tab [MDH],77535,CDM,,,0637,RC,00074-4341-13,NDC,facility,inpatient,1,EA,,2.83,1.7,2.32,2.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING MEPITEL ONE 2 X 3,5695915,CDM,A6206,CPT,0272,RC,,,facility,inpatient,,,,2.84,1.7,2.33,2.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 600 mg ER Tab [MDH],71150,CDM,,,0637,RC,63824-0008-15,NDC,facility,inpatient,1,EA,,2.84,1.7,2.33,2.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROmorphone 2 mg Tab [MDH],46290,CDM,,,0637,RC,00406-3243-01,NDC,facility,inpatient,1,EA,,2.85,1.71,2.34,2.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atropine-diphenoxylate 0.025 mg-2.5 mg Tab [MDH],74690,CDM,,,0637,RC,51079-0067-20,NDC,facility,inpatient,1,EA,,2.85,1.71,2.34,2.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 25 mcg (0.025 mg) Tab [MDH],77535,CDM,,,0637,RC,51079-0444-20,NDC,facility,inpatient,1,EA,,2.85,1.71,2.34,2.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ondansetron 4 mg Dis Tab [MDH],78039,CDM,,,0636,RC,68001-0246-16,NDC,facility,inpatient,1,EA,,2.85,1.71,2.34,2.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WASHER 7.0MM SMALL SCREWS,1297562,CDM,C1713,CPT,0278,RC,,,facility,inpatient,,,,2.86,1.72,2.35,2.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE N-879-H  0  CHROMIC,3163104,CDM,,,0272,RC,,,facility,inpatient,,,,2.86,1.72,2.35,2.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NEEDLE ANCHOR SURG #1824-5D,3112802,CDM,,,0278,RC,,,facility,inpatient,,,,2.87,1.72,2.35,2.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE L886T 0 CT BLACK 48,3268313,CDM,,,0272,RC,,,facility,inpatient,,,,2.87,1.72,2.35,2.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 10 mg Tab [MDH],78340,CDM,,,0637,RC,68084-0166-01,NDC,facility,inpatient,1,EA,,2.87,1.72,2.35,2.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
promethazine 12.5 mg Tab,71416,CDM,,,0637,RC,68001-0161-00,NDC,facility,inpatient,1,EA,,2.88,1.73,2.36,2.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 250 mg Tab,73355,CDM,,,0637,RC,60687-0526-01,NDC,facility,inpatient,1,EA,,2.88,1.73,2.36,2.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 1 mg Tab [MDH],73690,CDM,,,0637,RC,51079-0734-20,NDC,facility,inpatient,1,EA,,2.88,1.73,2.36,2.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 1 mg Tab,73690,CDM,,,0637,RC,58657-0901-01,NDC,facility,inpatient,1,EA,,2.88,1.73,2.36,2.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 10 mg Tab,76705,CDM,,,0637,RC,00555-0779-02,NDC,facility,inpatient,1,EA,,2.88,1.73,2.36,2.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 10 mg Tab [MDH],76705,CDM,,,0637,RC,59762-0056-01,NDC,facility,inpatient,1,EA,,2.88,1.73,2.36,2.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 10 mg Tab,76705,CDM,,,0637,RC,59762-3742-02,NDC,facility,inpatient,1,EA,,2.88,1.73,2.36,2.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8455-H   1-0 PROLENE,3258304,CDM,,,0272,RC,,,facility,inpatient,,,,2.89,1.73,2.37,2.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 50 mcg (0.05 mg) Tab,77525,CDM,,,0637,RC,68180-0966-01,NDC,facility,inpatient,1,EA,,2.89,1.73,2.37,2.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxybutynin 5 mg Tab [MDH],72765,CDM,,,0637,RC,68084-0400-01,NDC,facility,inpatient,1,EA,,2.9,1.74,2.38,2.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
allopurinol 100 mg Tab *,78710,CDM,,,0250,RC,60687-0677-01,NDC,facility,inpatient,1,EA,,2.9,1.74,2.38,2.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  814-H     2  GUT CHR C,3158007,CDM,,,0272,RC,,,facility,inpatient,,,,2.91,1.75,2.39,2.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-10 mg Tab [MDH],70140,CDM,,,0636,RC,00904-6825-61,NDC,facility,inpatient,1,EA,,2.91,1.75,2.39,2.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
primidone 50 mg Tab [MDH],71166,CDM,,,0250,RC,00527-1301-01,NDC,facility,inpatient,1,EA,,2.91,1.75,2.39,2.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
POUCH FECAL COLLECTOR 9821,2101105,CDM,A4330,CPT,0272,RC,,,facility,inpatient,,,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
montelukast 10 mg Tab [MDH],70376,CDM,,,0637,RC,68001-0248-04,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
montelukast 10 mg Tab,70376,CDM,,,0637,RC,68001-0248-05,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrALAZINE 25 mg Tab [MDH],70605,CDM,,,0637,RC,50111-0327-01,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 20 mg Tab,73960,CDM,,,0637,RC,00378-0183-01,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 20 mg Tab,73960,CDM,,,0637,RC,00591-5555-01,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 20 mg Tab [MDH],73960,CDM,,,0637,RC,23155-0111-01,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dilTIAZem 180 mg/24 hours Cap [MDH],75203,CDM,,,0637,RC,60687-0206-01,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus,75573,CDM,,,0637,RC,00121-0854-16,NDC,facility,inpatient,473,ML,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenazopyridine 100 mg Tab [MDH],76735,CDM,,,0637,RC,68084-0292-01,NDC,facility,inpatient,1,EA,,2.92,1.75,2.39,2.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND PLAIN 2,2194102,CDM,,,0272,RC,,,facility,inpatient,,,,2.93,1.76,2.4,2.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
GELFOAM SPONGE 12-7MM,3200604,CDM,,,0272,RC,,,facility,inpatient,,,,2.93,1.76,2.4,2.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fluorescein ophthalmic 1 mg Tes,72101,CDM,,,0636,RC,51801-0009-40,NDC,facility,inpatient,1,EA,,2.93,1.76,2.4,2.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amitriptyline 25 mg Tab,73045,CDM,,,0637,RC,60687-0433-01,NDC,facility,inpatient,1,EA,,2.94,1.76,2.41,2.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 20 mg Tab [MDH],74557,CDM,,,0637,RC,00054-8297-25,NDC,facility,inpatient,1,EA,,2.94,1.76,2.41,2.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 180 mg/24 hours ERCap [MDH],75203,CDM,,,0637,RC,68084-0053-01,NDC,facility,inpatient,1,EA,,2.94,1.76,2.41,2.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE  5% LR 1000ML BAG,3007006,CDM,,,0272,RC,,,facility,inpatient,,,,2.95,1.77,2.42,2.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMOSOL R 1000ML BAG,3016502,CDM,,,0274,RC,,,facility,inpatient,,,,2.95,1.77,2.42,2.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.42,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE SA-85H 2-0 SILK,3269802,CDM,,,0272,RC,,,facility,inpatient,,,,2.96,1.78,2.43,2.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab,41436,CDM,,,0636,RC,68084-0753-65,NDC,facility,inpatient,1,EA,,2.96,1.78,2.43,2.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atorvastatin 40 mg Tab [MDH],71346,CDM,,,0636,RC,51079-0210-20,NDC,facility,inpatient,1,EA,,2.96,1.78,2.43,2.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol succinate 12.5 mg ER Tab (1/2) [MDH],71874,CDM,,,0637,RC,64679-0734-02A,NDC,facility,inpatient,1,EA,,2.96,1.78,2.43,2.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE 5 mg Tab [MDH],72541,CDM,,,0637,RC,51079-0873-20,NDC,facility,inpatient,1,EA,,2.96,1.78,2.43,2.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
MONOCRYL 4-0 RB-1 27 VIOLET,3153313,CDM,,,0272,RC,,,facility,inpatient,,,,2.97,1.78,2.44,2.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sertraline 100 mg Tab,75141,CDM,,,0637,RC,60687-0253-01,NDC,facility,inpatient,1,EA,,2.97,1.78,2.44,2.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrALAZINE 10 mg Tab [MDH],70600,CDM,,,0637,RC,68084-0447-01,NDC,facility,inpatient,1,EA,,2.98,1.79,2.44,2.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ziprasidone 20 mg Cap [MDH],71823,CDM,,,0637,RC,51079-0351-16,NDC,facility,inpatient,1,EA,,2.98,1.79,2.44,2.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 80 mg Tab [MDH],78507,CDM,,,0637,RC,00591-0343-01,NDC,facility,inpatient,1,EA,,2.98,1.79,2.44,2.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-699-H    1  VICRYL  O,3172107,CDM,,,0272,RC,,,facility,inpatient,,,,2.99,1.79,2.45,2.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 100 mg Cap,70221,CDM,,,0637,RC,65162-0101-10,NDC,facility,inpatient,1,EA,,2.99,1.79,2.45,2.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0250,RC,00406-0365-01,NDC,facility,inpatient,1,EA,,3,1.8,2.46,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0250,RC,53746-0109-01,NDC,facility,inpatient,1,EA,,3,1.8,2.46,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxyCODONE 5 mg Tab [MDH],70223,CDM,,,0636,RC,00406-0552-62,NDC,facility,inpatient,1,EA,,3,1.8,2.46,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxyCODONE 5 mg Tab [MDH],70223,CDM,,,0637,RC,68084-0354-01,NDC,facility,inpatient,1,EA,,3,1.8,2.46,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thioridazine 10 mg Tab,75000,CDM,,,0637,RC,51079-0565-20,NDC,facility,inpatient,1,EA,,3,1.8,2.46,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 50 mcg (0.05 mg) Tab [MDH],77525,CDM,,,0637,RC,51079-0440-20,NDC,facility,inpatient,1,EA,,3,1.8,2.46,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE SA-86-G  0 SILK SUTUPAK,3269104,CDM,,,0272,RC,,,facility,inpatient,,,,3.01,1.81,2.47,3.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 10 mEq ER Tab [MDH],71474,CDM,,,0250,RC,63739-0446-10,NDC,facility,inpatient,1,EA,,3.01,1.81,2.47,3.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
labetalol 100 mg Tab UD [MDH],72264,CDM,,,0637,RC,60687-0439-01,NDC,facility,inpatient,1,EA,,3.01,1.81,2.47,3.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 75 mcg (0.075 mg) Tab,70160,CDM,,,0637,RC,00378-1805-77,NDC,facility,inpatient,1,EA,,3.02,1.81,2.48,3.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 75 mcg (0.075 mg) Tab,70160,CDM,,,0637,RC,68180-0967-09,NDC,facility,inpatient,1,EA,,3.02,1.81,2.48,3.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
trihexyphenidyl 2 mg Tab,70720,CDM,,,0637,RC,69452-0241-20,NDC,facility,inpatient,1,EA,,3.02,1.81,2.48,3.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
estradiol 0.5 mg Tab,72093,CDM,,,0636,RC,42806-0087-01,NDC,facility,inpatient,1,EA,,3.02,1.81,2.48,3.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
estradiol 0.5 mg Tab [MDH],72093,CDM,,,0636,RC,51862-0332-01,NDC,facility,inpatient,1,EA,,3.02,1.81,2.48,3.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
estradiol 0.5 mg Tab,72093,CDM,,,0636,RC,70954-0564-10,NDC,facility,inpatient,1,EA,,3.02,1.81,2.48,3.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 20 mg Tab,73960,CDM,,,0637,RC,60687-0598-01,NDC,facility,inpatient,1,EA,,3.03,1.82,2.48,3.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 50 mg Tab,74695,CDM,,,0637,RC,62332-0113-31,NDC,facility,inpatient,1,EA,,3.03,1.82,2.48,3.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL NORMOSOL M IN D5W 1000ML B,3015504,CDM,,,0270,RC,,,facility,inpatient,,,,3.04,1.82,2.49,3.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 88 mcg (0.088 mg) Tab [MDH],70308,CDM,,,0637,RC,00527-1344-01,NDC,facility,inpatient,1,EA,,3.04,1.82,2.49,3.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atropine-diphenoxylate 0.025 mg-2.5 mg Tab,74690,CDM,,,0637,RC,69315-0910-01,NDC,facility,inpatient,1,EA,,3.04,1.82,2.49,3.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 25 mcg Tab,77535,CDM,,,0637,RC,60687-0453-01,NDC,facility,inpatient,1,EA,,3.04,1.82,2.49,3.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXT. 5% 1/2 STR SAL 1000M,3006107,CDM,,,0272,RC,,,facility,inpatient,,,,3.05,1.83,2.5,3.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE X-496-T    2 ETHIBONC E,3141003,CDM,,,0272,RC,,,facility,inpatient,,,,3.05,1.83,2.5,3.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
promethazine 12.5 mg Tab [MDH],71416,CDM,,,0637,RC,68084-0154-01,NDC,facility,inpatient,1,EA,,3.05,1.83,2.5,3.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 50 mcg (0.05 mg) Tab,77525,CDM,,,0637,RC,60687-0464-01,NDC,facility,inpatient,1,EA,,3.06,1.84,2.51,3.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NEEDLE ANCHOR SURG 1824-6DC,3322919,CDM,,,0278,RC,,,facility,inpatient,,,,3.07,1.84,2.52,3.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 75 mcg (0.075 mg) Tab,70160,CDM,,,0637,RC,00527-3282-46,NDC,facility,inpatient,1,EA,,3.07,1.84,2.52,3.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 75 mcg (0.075 mg) Tab,70160,CDM,,,0637,RC,00781-5182-92,NDC,facility,inpatient,1,EA,,3.07,1.84,2.52,3.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 600 mg Tab,71150,CDM,,,0637,RC,00536-1163-61,NDC,facility,inpatient,1,EA,,3.07,1.84,2.52,3.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traZODone 50 mg Tab [MDH],72502,CDM,,,0637,RC,68084-0124-01,NDC,facility,inpatient,1,EA,,3.07,1.84,2.52,3.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 50 mg Tab [MDH],74695,CDM,,,0637,RC,51079-0801-20,NDC,facility,inpatient,1,EA,,3.07,1.84,2.52,3.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 80 mg Tab,78507,CDM,,,0637,RC,00904-2920-61,NDC,facility,inpatient,1,EA,,3.07,1.84,2.52,3.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHILON 6-0 PS-3 18 BLACK,3451717,CDM,,,0272,RC,,,facility,inpatient,,,,3.08,1.85,2.53,3.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
omeprazole 20 mg OTD [MDH],72319,CDM,,,0637,RC,46122-0616-04,NDC,facility,inpatient,1,EA,,3.08,1.85,2.53,3.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tamoxifen 10 mg Tab [MDH],75710,CDM,,,0637,RC,63739-0269-10,NDC,facility,inpatient,1,EA,,3.08,1.85,2.53,3.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 250 mg Tab [MDH],73355,CDM,,,0636,RC,00904-1453-61,NDC,facility,inpatient,1,EA,,3.09,1.85,2.53,3.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fluPHENAZine 1 mg Tab [MDH],76610,CDM,,,0637,RC,51079-0485-20,NDC,facility,inpatient,1,EA,,3.09,1.85,2.53,3.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  7-775  C-2  TEVDEK,3103501,CDM,,,0272,RC,,,facility,inpatient,,,,3.1,1.86,2.54,3.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 1 mg Tab,70072,CDM,,,0637,RC,65162-0761-10,NDC,facility,inpatient,1,EA,,3.1,1.86,2.54,3.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 100 mg Cap,70221,CDM,,,0637,RC,60687-0580-01,NDC,facility,inpatient,1,EA,,3.1,1.86,2.54,3.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 100 mg Cap [MDH],70221,CDM,,,0637,RC,68084-0594-01,NDC,facility,inpatient,1,EA,,3.1,1.86,2.54,3.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 100 mg Cap [MDH],70221,CDM,,,0637,RC,68084-0783-01,NDC,facility,inpatient,1,EA,,3.1,1.86,2.54,3.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 100 mcg (0.1 mg) Tab,77530,CDM,,,0637,RC,00527-1345-01,NDC,facility,inpatient,1,EA,,3.1,1.86,2.54,3.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
benztropine 0.5 mg Tab,71536,CDM,,,0637,RC,60687-0356-01,NDC,facility,inpatient,1,EA,,3.11,1.87,2.55,3.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 40 mg Tab [MDH],74555,CDM,,,0637,RC,00054-8299-25,NDC,facility,inpatient,1,EA,,3.11,1.87,2.55,3.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
labetalol 200 mg Tab [MDH],75741,CDM,,,0637,RC,68084-0456-01,NDC,facility,inpatient,1,EA,,3.11,1.87,2.55,3.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loratadine-pseudoePHEDrine 5 mg-120 mg ER Tab [MDH],79076,CDM,,,0637,RC,00573-2660-24,NDC,facility,inpatient,1,EA,,3.11,1.87,2.55,3.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8424-H     0  PROLENE C,3235508,CDM,,,0272,RC,,,facility,inpatient,,,,3.12,1.87,2.56,3.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aminophylline 25 mg/mL IV Sol - 20 mL [MDH],70421,CDM,,,0636,RC,00517-3820-25,NDC,facility,inpatient,20,ML,,3.12,1.87,2.56,3.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1667H 4/0 18,5690818,CDM,,,0270,RC,,,facility,inpatient,,,,3.13,1.88,2.57,3.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fenofibrate 48 mg Tab [MDH],70388,CDM,,,0637,RC,00074-6122-90,NDC,facility,inpatient,1,EA,,3.13,1.88,2.57,3.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dicyclomine 10 mg Cap [MDH],71125,CDM,,,0637,RC,51079-0118-20,NDC,facility,inpatient,1,EA,,3.13,1.88,2.57,3.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thioridazine 10 mg Tab [MDH],75000,CDM,,,0637,RC,00378-0612-01,NDC,facility,inpatient,1,EA,,3.13,1.88,2.57,3.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carisoprodol 350 mg Tab [MDH],77225,CDM,,,0637,RC,00603-2582-21,NDC,facility,inpatient,1,EA,,3.13,1.88,2.57,3.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carisoprodol 350 mg Tab,77225,CDM,,,0637,RC,50228-0109-01,NDC,facility,inpatient,1,EA,,3.13,1.88,2.57,3.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carisoprodol 350 mg Tab,77225,CDM,,,0637,RC,69584-0111-10,NDC,facility,inpatient,1,EA,,3.13,1.88,2.57,3.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHILEY DISPOSABLE INNER CANNULA SZ 6 - 7.5MM,2310318,CDM,A4623,CPT,0272,RC,,,facility,inpatient,,,,3.14,1.88,2.57,3.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 75 mcg (0.075 mg) Tab [MDH],70160,CDM,,,0637,RC,51079-0441-20,NDC,facility,inpatient,1,EA,,3.14,1.88,2.57,3.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levETIRAcetam 250 mg Tab [MDH],71437,CDM,,,0637,RC,68084-0859-01,NDC,facility,inpatient,1,EA,,3.14,1.88,2.57,3.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ziprasidone 20 mg Cap,71823,CDM,,,0637,RC,55111-0256-60,NDC,facility,inpatient,1,EA,,3.14,1.88,2.57,3.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE micronized 3 mg Tab [MDH],79976,CDM,,,0637,RC,67253-0461-10,NDC,facility,inpatient,1,EA,,3.14,1.88,2.57,3.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WASHER 13.0MM LARGE SCREWS,1297672,CDM,C1713,CPT,0278,RC,,,facility,inpatient,,,,3.15,1.89,2.58,3.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8411-H    2-0 PROLENE C,3213802,CDM,,,0272,RC,,,facility,inpatient,,,,3.15,1.89,2.58,3.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 2 mg/mL Inj Sol 1 mL [MDH],70813,CDM,,,0636,RC,00641-6048-25,NDC,facility,inpatient,1,ML,,3.15,1.89,2.58,3.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methocarbamol 750 mg Tab [MDH],76820,CDM,,,0637,RC,68084-0057-01,NDC,facility,inpatient,1,EA,,3.15,1.89,2.58,3.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY  8 FR 3CC SIL,2071201,CDM,A4344,CPT,0272,RC,,,facility,inpatient,,,,3.16,1.9,2.59,3.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-codeine 300 mg-30 mg Tab [MDH],46820,CDM,,,0637,RC,68084-0372-01,NDC,facility,inpatient,1,EA,,3.16,1.9,2.59,3.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 1 mg Tab [MDH],70072,CDM,,,0637,RC,51672-4027-01,NDC,facility,inpatient,1,EA,,3.16,1.9,2.59,3.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 88 mcg (0.088 mg) Tab,70308,CDM,,,0637,RC,42292-0038-20,NDC,facility,inpatient,1,EA,,3.16,1.9,2.59,3.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amiodarone 200 mg Tab [MDH],72102,CDM,,,0637,RC,68084-0371-01,NDC,facility,inpatient,1,EA,,3.16,1.9,2.59,3.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PACKING WOUND IODOFORM 2,2194003,CDM,,,0270,RC,,,facility,inpatient,,,,3.17,1.9,2.6,3.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE  5% INJ 1000ML BA,3004003,CDM,,,0272,RC,,,facility,inpatient,,,,3.17,1.9,2.6,3.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE MONOCRYL 1 Y399H,3249414,CDM,,,0272,RC,,,facility,inpatient,,,,3.17,1.9,2.6,3.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cefTRIAXone 250 mg Pow,76871,CDM,,,0636,RC,00409-7337-01,NDC,facility,inpatient,1,EA,,3.17,1.9,2.6,3.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cefTRIAXone 250 mg Pow,76871,CDM,,,0636,RC,00409-7337-20,NDC,facility,inpatient,1,EA,,3.17,1.9,2.6,3.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 22FR 30CC SILICONE,2064107,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.18,1.91,2.61,3.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 1 mg Tab,70072,CDM,,,0637,RC,00832-1211-01,NDC,facility,inpatient,1,EA,,3.18,1.91,2.61,3.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-7.5 mg Tab [MDH],71771,CDM,,,0637,RC,00406-0366-62,NDC,facility,inpatient,1,EA,,3.18,1.91,2.61,3.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab,78657,CDM,,,0637,RC,59762-3719-01,NDC,facility,inpatient,1,EA,,3.18,1.91,2.61,3.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE Z-340-H    0  PDS VIL,3277500,CDM,,,0272,RC,,,facility,inpatient,,,,3.19,1.91,2.62,3.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
predniSONE 10 mg Tab,76521,CDM,,,0636,RC,59746-0173-06,NDC,facility,inpatient,1,EA,,3.19,1.91,2.62,3.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 22FR 5CC SILIC,2075400,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.2,1.92,2.62,3.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0636,RC,60687-0396-01,NDC,facility,inpatient,1,EA,,3.2,1.92,2.62,3.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-hydrocodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0636,RC,68084-0895-01,NDC,facility,inpatient,1,EA,,3.2,1.92,2.62,3.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-hydrocodone 325 mg-7.5 mg Tab,71771,CDM,,,0637,RC,00904-6420-61,NDC,facility,inpatient,1,EA,,3.2,1.92,2.62,3.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE L-102-G   3-0 GUT PLAIN,3131004,CDM,,,0272,RC,,,facility,inpatient,,,,3.21,1.93,2.63,3.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atorvastatin 10 mg Tab [MDH],71593,CDM,,,0637,RC,68084-0097-01,NDC,facility,inpatient,1,EA,,3.21,1.93,2.63,3.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clindamycin 150 mg Cap [MDH],71775,CDM,,,0250,RC,68084-0243-01,NDC,facility,inpatient,1,EA,,3.21,1.93,2.63,3.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 5 mg Tab [MDH],71458,CDM,,,0637,RC,31722-0529-01,NDC,facility,inpatient,1,EA,,3.22,1.93,2.64,3.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 5 mg Tab [MDH],71458,CDM,,,0637,RC,60505-0232-01,NDC,facility,inpatient,1,EA,,3.22,1.93,2.64,3.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 5 mg Tab,71458,CDM,,,0637,RC,65862-0125-01,NDC,facility,inpatient,1,EA,,3.22,1.93,2.64,3.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-7.5 mg Tab [MDH],71771,CDM,,,0637,RC,68084-0863-01,NDC,facility,inpatient,1,EA,,3.22,1.93,2.64,3.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fluPHENAZine 1 mg Tab [MDH],76610,CDM,,,0637,RC,00378-6004-01,NDC,facility,inpatient,1,EA,,3.22,1.93,2.64,3.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab [MDH],78657,CDM,,,0637,RC,00904-5858-61,NDC,facility,inpatient,1,EA,,3.22,1.93,2.64,3.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab [MDH],78657,CDM,,,0637,RC,51079-0788-20,NDC,facility,inpatient,1,EA,,3.22,1.93,2.64,3.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylphenidate 5 mg Tab [MDH],46670,CDM,,,0637,RC,53014-0531-07,NDC,facility,inpatient,1,EA,,3.23,1.94,2.65,3.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amitriptyline 25 mg Tab [MDH],73045,CDM,,,0637,RC,51079-0107-20,NDC,facility,inpatient,1,EA,,3.23,1.94,2.65,3.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carBAMazepine 100 mg Tab,77686,CDM,,,0637,RC,00904-3854-61,NDC,facility,inpatient,1,EA,,3.23,1.94,2.65,3.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab,70815,CDM,,,0637,RC,00093-3425-01,NDC,facility,inpatient,1,EA,,3.24,1.94,2.66,3.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab,70815,CDM,,,0637,RC,00591-0240-01,NDC,facility,inpatient,1,EA,,3.24,1.94,2.66,3.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab,70815,CDM,,,0637,RC,00591-0240-10,NDC,facility,inpatient,1,EA,,3.24,1.94,2.66,3.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab,70815,CDM,,,0637,RC,69315-0904-01,NDC,facility,inpatient,1,EA,,3.24,1.94,2.66,3.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 2.5 mg Tab [MDH],71427,CDM,,,0637,RC,00378-2072-01,NDC,facility,inpatient,1,EA,,3.24,1.94,2.66,3.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 2 mg Tab,72130,CDM,,,0637,RC,00832-1212-01,NDC,facility,inpatient,1,EA,,3.24,1.94,2.66,3.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 100 mg Cap,72650,CDM,,,0637,RC,51672-4111-01,NDC,facility,inpatient,1,EA,,3.24,1.94,2.66,3.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SLING ARM SM SPECIALTY 10103,2228108,CDM,A4565,CPT,0272,RC,,,facility,inpatient,,,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SLING ARM SPECIALTY MED10104,2228207,CDM,A4565,CPT,0272,RC,,,facility,inpatient,,,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SLING ARM SPECIALTY LRG10105,2228306,CDM,A4565,CPT,0272,RC,,,facility,inpatient,,,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SLING ARM SPECIALTY XLG#1796,2228405,CDM,,,0272,RC,,,facility,inpatient,,,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - GUEST BREAKFAST,66004,CDM,,,0991,RC,,,facility,inpatient,,,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 2.5 mg Tab [MDH],71427,CDM,,,0637,RC,16729-0194-01,NDC,facility,inpatient,1,EA,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin pediatric Supp [MDH],73640,CDM,,,0637,RC,00713-0102-13,NDC,facility,inpatient,1,EA,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ampicillin 500 mg Cap [MDH],74044,CDM,,,0637,RC,00781-2145-01,NDC,facility,inpatient,1,EA,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 0.5 mg/5 mL Oral Elix [MDH],75593,CDM,,,0637,RC,64980-0509-24,NDC,facility,inpatient,237,ML,,3.25,1.95,2.66,3.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 16FR 5CC,2064630,CDM,,,0272,RC,,,facility,inpatient,,,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 24FR 5CC,2064650,CDM,,,0272,RC,,,facility,inpatient,,,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER COUDE TIP RED RUBBER TIEMANN 22FR LATEX,3208510,CDM,,,0272,RC,,,facility,inpatient,,,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER COUDE TIP RED RUBBER TIEMANN 24FR LATEX,3208515,CDM,,,0272,RC,,,facility,inpatient,,,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER COUDE TIP RED RUBBER TIEMANN 20FR LATEX,3208604,CDM,,,0272,RC,,,facility,inpatient,,,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE Z-341-H    1  PDS     C,3213901,CDM,,,0272,RC,,,facility,inpatient,,,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine hydrochloride 10 mg Tab,70810,CDM,,,0637,RC,00093-5060-01,NDC,facility,inpatient,1,EA,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 2.5 mg Tab [MDH],71427,CDM,,,0250,RC,68001-0211-00,NDC,facility,inpatient,1,EA,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 2.5 mg Tab,71427,CDM,,,0637,RC,68001-0332-00,NDC,facility,inpatient,1,EA,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab [MDH],78657,CDM,,,0637,RC,68084-0647-01,NDC,facility,inpatient,1,EA,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 112 mcg (0.112 mg) Tab [MDH],79978,CDM,,,0637,RC,00527-1346-01,NDC,facility,inpatient,1,EA,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 112 mcg (0.112 mg) Tab,79978,CDM,,,0637,RC,68180-0970-01,NDC,facility,inpatient,1,EA,,3.26,1.96,2.67,3.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SLING ARM SPECIALTY INFANT,2228009,CDM,,,0272,RC,,,facility,inpatient,,,,3.27,1.96,2.68,3.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE  5% INJ  500ML BA,3004508,CDM,,,0272,RC,,,facility,inpatient,,,,3.27,1.96,2.68,3.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXTROSE  5% INJ  250ML BA,3005000,CDM,,,0270,RC,,,facility,inpatient,,,,3.27,1.96,2.68,3.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PHOS-NAK K+ phosphate-Na+ phosphate 250 mg-280 mg-160 mg Pow UD [MDH],77068,CDM,,,0637,RC,60258-0006-01,NDC,facility,inpatient,1,EA,,3.27,1.96,2.68,3.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING XX-LRG REG KNEE,2120504,CDM,,,0270,RC,,,facility,inpatient,,,,3.28,1.97,2.69,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1660-G    6-0 ETHILON P,3167008,CDM,,,0272,RC,,,facility,inpatient,,,,3.28,1.97,2.69,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 125 mcg (0.125 mg) Tab,70095,CDM,,,0637,RC,00527-1347-01,NDC,facility,inpatient,1,EA,,3.28,1.97,2.69,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 3 mg Tab,70171,CDM,,,0250,RC,00832-1214-01,NDC,facility,inpatient,1,EA,,3.28,1.97,2.69,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dicyclomine 10 mg Cap,71125,CDM,,,0637,RC,60687-0369-01,NDC,facility,inpatient,1,EA,,3.28,1.97,2.69,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 2.5 mg Tab,72131,CDM,,,0637,RC,00832-1213-01,NDC,facility,inpatient,1,EA,,3.28,1.97,2.69,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carBAMazepine 100 mg Chew Tab [MDH],77686,CDM,,,0637,RC,51672-4041-01,NDC,facility,inpatient,1,EA,,3.28,1.97,2.69,3.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXT 5% 1/4 STR SALINE 500ML,3005208,CDM,,,0250,RC,,,facility,inpatient,,,,3.29,1.97,2.7,3.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CONVAFOAM ADH SIL 15X15CM,5697414,CDM,,,0270,RC,,,facility,inpatient,,,,3.29,1.97,2.7,3.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 0.5 mg Tab,70815,CDM,,,0637,RC,00591-0240-05,NDC,facility,inpatient,1,EA,,3.29,1.97,2.7,3.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 100 mcg (0.1 mg) Tab [MDH],77530,CDM,,,0637,RC,51079-0442-20,NDC,facility,inpatient,1,EA,,3.29,1.97,2.7,3.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 400 mg-80 mg Tab [MDH],78041,CDM,,,0637,RC,00527-1442-01,NDC,facility,inpatient,1,EA,,3.29,1.97,2.7,3.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 400 mg-80 mg Tab,78041,CDM,,,0637,RC,65862-0419-01,NDC,facility,inpatient,1,EA,,3.29,1.97,2.7,3.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 14FR 5CC,2064625,CDM,,,0272,RC,,,facility,inpatient,,,,3.3,1.98,2.71,3.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHIBOND 4-0 RB-1 30 GREEN,3254509,CDM,,,0272,RC,,,facility,inpatient,,,,3.3,1.98,2.71,3.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NEEDLE PERC ENTRY,4386103,CDM,,,0270,RC,,,facility,inpatient,,,,3.3,1.98,2.71,3.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlordiazePOXIDE 25 mg Cap [MDH],74595,CDM,,,0637,RC,51079-0141-20,NDC,facility,inpatient,1,EA,,3.3,1.98,2.71,3.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Zolpidem Tartrate Tab CR 6.25 MG [MDH],71738,CDM,,,0637,RC,68258-7145-03,NDC,facility,inpatient,1,EA,,3.31,1.99,2.71,3.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 250 mg Tab [MDH],73355,CDM,,,0637,RC,68084-0216-01,NDC,facility,inpatient,1,EA,,3.31,1.99,2.71,3.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 12FR  5CC SILIC,2066102,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.32,1.99,2.72,3.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amoxicillin 250 mg Chew Tab [MDH],70469,CDM,,,0637,RC,00093-2268-01,NDC,facility,inpatient,1,EA,,3.32,1.99,2.72,3.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PHENobarbital 32.4 mg Tab [MDH],76320,CDM,,,0637,RC,00603-5166-21,NDC,facility,inpatient,1,EA,,3.32,1.99,2.72,3.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loratadine-pseudoephedrine 5 mg-120 mg Tab,79076,CDM,,,0637,RC,80070-0100-12,NDC,facility,inpatient,1,EA,,3.32,1.99,2.72,3.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 100 mg ERCap [MDH],72650,CDM,,,0637,RC,51079-0905-20,NDC,facility,inpatient,1,EA,,3.33,2,2.73,3.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
estradiol 1 mg Tab [MDH],73240,CDM,,,0637,RC,00591-0487-01,NDC,facility,inpatient,1,EA,,3.33,2,2.73,3.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
estradiol 1 mg Tab,73240,CDM,,,0637,RC,42806-0088-01,NDC,facility,inpatient,1,EA,,3.33,2,2.73,3.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
estradiol 1 mg Tab,73240,CDM,,,0637,RC,51862-0333-01,NDC,facility,inpatient,1,EA,,3.33,2,2.73,3.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 4925-H  1 CHROM M-04,3216102,CDM,,,0272,RC,,,facility,inpatient,,,,3.35,2.01,2.75,3.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE X-558-H   3-0 ETHIBOND,3264409,CDM,,,0272,RC,,,facility,inpatient,,,,3.35,2.01,2.75,3.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 5 mg Tab,72135,CDM,,,0637,RC,00832-1216-01,NDC,facility,inpatient,1,EA,,3.35,2.01,2.75,3.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Penicillin V Potassium 250 mg Tab [MDH],74563,CDM,,,0637,RC,00781-1205-01,NDC,facility,inpatient,1,EA,,3.35,2.01,2.75,3.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fluPHENAZine 2.5 mg Tab [MDH],76615,CDM,,,0637,RC,51079-0486-20,NDC,facility,inpatient,1,EA,,3.35,2.01,2.75,3.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING ALLEVYN 5X5 W/BORDER,2226004,CDM,A6212,CPT,0272,RC,,,facility,inpatient,,,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER COUDE TIP RED RUBBER TIEMANN 18FR LATEX,3208505,CDM,,,0272,RC,,,facility,inpatient,,,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fentaNYL 0.05 mg/mL Inj Sol 2mL [MDH],46765,CDM,,,0636,RC,00409-9094-11,NDC,facility,inpatient,2,ML,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg Tab,70007,CDM,,,0637,RC,60687-0620-01,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0250,RC,00406-0123-01,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0250,RC,27808-0035-01,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atorvastatin 40 mg Tab,71346,CDM,,,0250,RC,00904-6292-61,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
megestrol 20 mg Tab [MDH],72312,CDM,,,0637,RC,64380-0158-01,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cephalexin 250 mg Cap [MDH],74270,CDM,,,0636,RC,68180-0121-01,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nitroglycerin 2.5 mg ERCap [MDH],75660,CDM,,,0637,RC,00904-0643-60,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carBAMazepine 100 mg Tab,77686,CDM,,,0637,RC,13668-0271-01,NDC,facility,inpatient,1,EA,,3.36,2.02,2.76,3.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 100 mg Cap [MDH],72650,CDM,,,0637,RC,68084-0376-01,NDC,facility,inpatient,1,EA,,3.37,2.02,2.76,3.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab,78657,CDM,,,0637,RC,00228-2027-10,NDC,facility,inpatient,1,EA,,3.37,2.02,2.76,3.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab,78657,CDM,,,0637,RC,65862-0676-01,NDC,facility,inpatient,1,EA,,3.37,2.02,2.76,3.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.25 mg Tab,78657,CDM,,,0637,RC,67253-0900-10,NDC,facility,inpatient,1,EA,,3.37,2.02,2.76,3.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 88 mcg Tab,70308,CDM,,,0637,RC,00904-6952-61,NDC,facility,inpatient,1,EA,,3.38,2.03,2.77,3.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 88 mcg (0.088 mg) Tab,70308,CDM,,,0637,RC,60687-0486-01,NDC,facility,inpatient,1,EA,,3.38,2.03,2.77,3.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meclizine 12.5 mg Tab,70555,CDM,,,0637,RC,50268-0522-15,NDC,facility,inpatient,1,EA,,3.38,2.03,2.77,3.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atropine-diphenoxylate 0.025 mg-2.5 mg Tab,74690,CDM,,,0637,RC,00406-1236-01,NDC,facility,inpatient,1,EA,,3.38,2.03,2.77,3.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
labetalol 200 mg Tab,75741,CDM,,,0250,RC,60687-0450-01,NDC,facility,inpatient,1,EA,,3.38,2.03,2.77,3.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg Tab,79500,CDM,,,0636,RC,60687-0155-01,NDC,facility,inpatient,1,EA,,3.38,2.03,2.77,3.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg Tab [MDH],79500,CDM,,,0637,RC,62584-0259-01,NDC,facility,inpatient,1,EA,,3.38,2.03,2.77,3.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 100 mcg (0.1 mg) Tab,77530,CDM,,,0637,RC,00904-6953-61,NDC,facility,inpatient,1,EA,,3.39,2.03,2.78,3.39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.39,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loratadine 10 mg Tab [MDH],79075,CDM,,,0250,RC,68084-0248-01,NDC,facility,inpatient,1,EA,,3.39,2.03,2.78,3.39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.39,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE micronized 3 mg Tab [MDH],79976,CDM,,,0637,RC,00378-1125-01,NDC,facility,inpatient,1,EA,,3.39,2.03,2.78,3.39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.39,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CAP DIGITAL GEL/RIBBED KNIT FABRIC/MINERAL OIL,2221060,CDM,,,0270,RC,,,facility,inpatient,,,,3.4,2.04,2.79,3.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sucralfate 1 g Tab [MDH],71498,CDM,,,0637,RC,00591-0780-01,NDC,facility,inpatient,1,EA,,3.4,2.04,2.79,3.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 10 mg-100 mg Tab [MDH],77065,CDM,,,0637,RC,62756-0517-88,NDC,facility,inpatient,1,EA,,3.4,2.04,2.79,3.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 112 mcg (0.112 mg) Tab,79978,CDM,,,0637,RC,42292-0039-20,NDC,facility,inpatient,1,EA,,3.4,2.04,2.79,3.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 20FR 5CC,2064640,CDM,,,0272,RC,,,facility,inpatient,,,,3.41,2.05,2.8,3.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 22FR 5CC,2064645,CDM,,,0272,RC,,,facility,inpatient,,,,3.41,2.05,2.8,3.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROmorphone 2 mg Tab [MDH],46290,CDM,,,0637,RC,68084-0423-01,NDC,facility,inpatient,1,EA,,3.41,2.05,2.8,3.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 25 mg Tab [MDH],70064,CDM,,,0637,RC,00904-5392-61,NDC,facility,inpatient,1,EA,,3.41,2.05,2.8,3.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meclizine 12.5 mg Tab [MDH],70555,CDM,,,0637,RC,51079-0089-20,NDC,facility,inpatient,1,EA,,3.41,2.05,2.8,3.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cephalexin 250 mg Cap,74270,CDM,,,0637,RC,60687-0152-01,NDC,facility,inpatient,1,EA,,3.41,2.05,2.8,3.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  697-G    6-0 ETHILONN,3211004,CDM,,,0272,RC,,,facility,inpatient,,,,3.42,2.05,2.8,3.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROmorphone 2 mg Tab [MDH],46290,CDM,,,0637,RC,42858-0301-25,NDC,facility,inpatient,1,EA,,3.42,2.05,2.8,3.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenol topical - Liq [MDH],71978,CDM,,,0637,RC,38779-1938-05,NDC,facility,inpatient,100,ML,,3.42,2.05,2.8,3.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
imipramine 25 mg Tab [MDH],78070,CDM,,,0637,RC,00781-1764-01,NDC,facility,inpatient,1,EA,,3.42,2.05,2.8,3.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
imipramine 25 mg Tab [MDH],78070,CDM,,,0637,RC,49884-0055-01,NDC,facility,inpatient,1,EA,,3.42,2.05,2.8,3.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
imipramine 25 mg Tab,78070,CDM,,,0637,RC,69315-0134-01,NDC,facility,inpatient,1,EA,,3.42,2.05,2.8,3.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 125 mcg (0.125 mg) Tab [MDH],70095,CDM,,,0637,RC,51079-0443-20,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levETIRAcetam 500 mg Tab,71169,CDM,,,0637,RC,60687-0657-01,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levETIRAcetam 500 mg Tab [MDH],71169,CDM,,,0637,RC,68084-0870-01,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxybutynin 5 mg Tab [MDH],72765,CDM,,,0637,RC,00904-2821-61,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxyBUTYnin 5 mg Tab,72765,CDM,,,0637,RC,00904-7027-61,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ergocalciferol 50000 intl units Cap,72890,CDM,,,0637,RC,69452-0151-20,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 10 mg Tab [MDH],76775,CDM,,,0637,RC,68084-0676-01,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 400 mg-80 mg Tab,78041,CDM,,,0637,RC,60687-0542-21,NDC,facility,inpatient,1,EA,,3.43,2.06,2.81,3.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methocarbamol 750 mg Tab,76820,CDM,,,0636,RC,70010-0770-01,NDC,facility,inpatient,1,EA,,3.44,2.06,2.82,3.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methocarbamol 750 mg Tab,76820,CDM,,,0636,RC,76385-0124-01,NDC,facility,inpatient,1,EA,,3.44,2.06,2.82,3.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER COUDE TIP RED RUBBER TIEMANN 16FR LATEX,3178605,CDM,A4340,CPT,0272,RC,,,facility,inpatient,,,,3.45,2.07,2.83,3.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
benzonatate 100 mg Cap [MDH],77765,CDM,,,0637,RC,68084-0214-01,NDC,facility,inpatient,1,EA,,3.45,2.07,2.83,3.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.28,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL DEXT. 5% 1/4 STR SAL 1000M,3005406,CDM,,,0272,RC,,,facility,inpatient,,,,3.46,2.08,2.84,3.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
psyllium 3.4 g/12 g Pow [MDH],71322,CDM,,,0637,RC,37000-0023-04,NDC,facility,inpatient,1,EA,,3.46,2.08,2.84,3.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 10 mg Cap [MDH],75982,CDM,,,0637,RC,51672-4001-01,NDC,facility,inpatient,1,EA,,3.46,2.08,2.84,3.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 16FR  5CC SILIC,2066409,CDM,A4344,CPT,0272,RC,,,facility,inpatient,,,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 18FR  5CC SILIC,2066708,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 10FR  3CC SIL,2067902,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 24FR  5CC SILIC,2076409,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SPONGE NEUROLOGICAL 1/2 X 3,3121405,CDM,,,0272,RC,,,facility,inpatient,,,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1964-G    4-0 ETHILON,3160409,CDM,,,0272,RC,,,facility,inpatient,,,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER COUDE TIP RED RUBBER TIEMANN 14FR LATEX,3178500,CDM,,,0272,RC,,,facility,inpatient,,,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylphenidate 5 mg Tab [MDH],46670,CDM,,,0637,RC,00603-4576-21,NDC,facility,inpatient,1,EA,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bisacodyl 10 mg Supp [MDH],71285,CDM,,,0637,RC,00713-0109-50,NDC,facility,inpatient,1,EA,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.5 mg Tab,71808,CDM,,,0637,RC,00904-5859-61,NDC,facility,inpatient,1,EA,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 4 mg/mL Sol,79901,CDM,,,0636,RC,67457-0423-12,NDC,facility,inpatient,1,ML,,3.47,2.08,2.85,3.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 14FR  5CC SILIC,2066203,CDM,A4344,CPT,0272,RC,,,facility,inpatient,,,,3.48,2.09,2.85,3.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg Tab,71385,CDM,,,0637,RC,62756-0142-01,NDC,facility,inpatient,1,EA,,3.49,2.09,2.86,3.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 10 mg Cap,75982,CDM,,,0637,RC,75907-0069-01,NDC,facility,inpatient,1,EA,,3.49,2.09,2.86,3.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 5 mg Tab,71383,CDM,,,0637,RC,16729-0200-16,NDC,facility,inpatient,1,EA,,3.5,2.1,2.87,3.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide mononitrate 15 mg ER Tab (1/2) [MDH],71866,CDM,,,0637,RC,00143-2230-01A,NDC,facility,inpatient,1,EA,,3.5,2.1,2.87,3.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  490-T    2  ETHILON  L,3170002,CDM,,,0272,RC,,,facility,inpatient,,,,3.51,2.11,2.88,3.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.51,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.5 mg Tab [MDH],71808,CDM,,,0637,RC,51079-0789-20,NDC,facility,inpatient,1,EA,,3.52,2.11,2.89,3.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
allopurinol 300 mg Tab [MDH],78715,CDM,,,0637,RC,51079-0206-20,NDC,facility,inpatient,1,EA,,3.52,2.11,2.89,3.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,2.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide dinitrate 10 mg Tab,74180,CDM,,,0637,RC,00904-6619-61,NDC,facility,inpatient,1,EA,,3.53,2.12,2.89,3.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.53,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thioridazine 25 mg Tab [MDH],75010,CDM,,,0637,RC,51079-0566-20,NDC,facility,inpatient,1,EA,,3.53,2.12,2.89,3.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.53,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-593-G   5-0 VICRYL PS,3171802,CDM,,,0272,RC,,,facility,inpatient,,,,3.54,2.12,2.9,3.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HEEL-ELBOW PROTECTOR,2129009,CDM,,,0270,RC,,,facility,inpatient,,,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-834-G  5-0 VICRYL PC-,3259303,CDM,,,0272,RC,,,facility,inpatient,,,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
(DO NOT ORDER - DISCONTINUED PART # 1965G),3260704,CDM,,,0272,RC,,,facility,inpatient,,,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1955-G    5-0 ETHILON P,3263500,CDM,,,0272,RC,,,facility,inpatient,,,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 5 mg Tab,71383,CDM,,,0637,RC,00093-0053-01,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 5 mg Tab,71383,CDM,,,0637,RC,16729-0200-01,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 5 mg Tab [MDH],71383,CDM,,,0637,RC,51079-0985-20,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 5 mg Tab [MDH],71383,CDM,,,0637,RC,68084-0028-01,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-7.5 mg Tab [MDH],71771,CDM,,,0637,RC,00406-0124-01,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-7.5 mg Tab [MDH],71771,CDM,,,0637,RC,60687-0407-01,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fluorescein ophthalmic 1 mg Tes [MDH],72101,CDM,,,0636,RC,17238-0900-11,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 10 mg-100 mg Tab,77065,CDM,,,0637,RC,00093-9701-01,NDC,facility,inpatient,1,EA,,3.55,2.13,2.91,3.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
donepezil 5 mg Tab UD [MDH],72263,CDM,,,0637,RC,60687-0292-01,NDC,facility,inpatient,1,EA,,3.56,2.14,2.92,3.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE 5 mg Tab,72541,CDM,,,0637,RC,00093-9364-01,NDC,facility,inpatient,1,EA,,3.56,2.14,2.92,3.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE 5 mg Tab,72541,CDM,,,0637,RC,72241-0040-05,NDC,facility,inpatient,1,EA,,3.56,2.14,2.92,3.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
naproxen 250 mg Tab [MDH],75405,CDM,,,0637,RC,68462-0188-01,NDC,facility,inpatient,1,EA,,3.56,2.14,2.92,3.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 400 mg-80 mg Tab [MDH],78041,CDM,,,0637,RC,53746-0271-01,NDC,facility,inpatient,1,EA,,3.56,2.14,2.92,3.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHILON 4-0 PC-1 18 BLACK,3223208,CDM,,,0272,RC,,,facility,inpatient,,,,3.57,2.14,2.93,3.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg Tab [MDH],79500,CDM,,,0637,RC,51079-0172-20,NDC,facility,inpatient,1,EA,,3.57,2.14,2.93,3.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 18FR 5CC,2064635,CDM,,,0272,RC,,,facility,inpatient,,,,3.58,2.15,2.94,3.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
minoxidil 2.5 mg Tab [MDH],72314,CDM,,,0637,RC,49884-0256-01,NDC,facility,inpatient,1,EA,,3.58,2.15,2.94,3.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE NYLON ETHILON 5-0 3/8 CIRCLE PC-3,3131509,CDM,,,0272,RC,,,facility,inpatient,,,,3.59,2.15,2.94,3.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL SOD CHL .9% ADVAN 250ML,3007709,CDM,,,0272,RC,,,facility,inpatient,,,,3.6,2.16,2.95,3.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fludrocortisone 0.1 mg Tab [MDH],73363,CDM,,,0637,RC,00555-0997-02,NDC,facility,inpatient,1,EA,,3.6,2.16,2.95,3.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHILON 5-0 PC-5 18 BLACK,3257809,CDM,,,0272,RC,,,facility,inpatient,,,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0250,RC,00406-0123-62,NDC,facility,inpatient,1,EA,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 10 mg/mL Sol,70176,CDM,,,0636,RC,70860-0751-02,NDC,facility,inpatient,2,ML,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.5 mg Tab [MDH],71808,CDM,,,0637,RC,68084-0672-01,NDC,facility,inpatient,1,EA,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
labetalol 200 mg Tab [MDH],75741,CDM,,,0637,RC,51079-0929-20,NDC,facility,inpatient,1,EA,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
promethazine 25 mg/mL Inj Sol 1 mL [MDH],76245,CDM,,,0636,RC,00641-0948-35,NDC,facility,inpatient,1,ML,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
promethazine 25 mg/mL Inj Sol 1 mL [MDH],76245,CDM,,,0636,RC,00641-0955-25,NDC,facility,inpatient,1,ML,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traMADol 50 mg Tab [MDH],79066,CDM,,,0637,RC,51079-0991-20,NDC,facility,inpatient,1,EA,,3.61,2.17,2.96,3.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ADJUST-A-LIFT HEEL LIFT SMALL,2221115,CDM,,,0270,RC,,,facility,inpatient,,,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ADJUST-A-LIFT HEEL LIFT MEDIUM,2221116,CDM,,,0270,RC,,,facility,inpatient,,,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ADJUST-A-LIFT HEEL LIFT LARGE,2221117,CDM,,,0270,RC,,,facility,inpatient,,,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 25 mg Tab [MDH],70064,CDM,,,0637,RC,51079-0759-20,NDC,facility,inpatient,1,EA,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
memantine 10 mg Tab [MDH],70078,CDM,,,0250,RC,60687-0184-57,NDC,facility,inpatient,1,EA,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sucralfate 1 g Tab [MDH],71498,CDM,,,0637,RC,00093-2210-01,NDC,facility,inpatient,1,EA,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
memantine 5 mg Tab UD [MDH],72259,CDM,,,0637,RC,60687-0173-57,NDC,facility,inpatient,1,EA,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
naproxen 250 mg Tab [MDH],75405,CDM,,,0637,RC,51079-0793-20,NDC,facility,inpatient,1,EA,,3.62,2.17,2.97,3.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diclofenac sodium 75 mg Tab,70060,CDM,,,0637,RC,68084-0333-01,NDC,facility,inpatient,1,EA,,3.63,2.18,2.98,3.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dilTIAZem 240 mg/24 hours Cap,71441,CDM,,,0637,RC,60687-0217-01,NDC,facility,inpatient,1,EA,,3.63,2.18,2.98,3.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 240 mg/24 hours ERCap [MDH],71441,CDM,,,0637,RC,68084-0054-01,NDC,facility,inpatient,1,EA,,3.63,2.18,2.98,3.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 800 mg Tab,75217,CDM,,,0637,RC,64380-0807-06,NDC,facility,inpatient,1,EA,,3.63,2.18,2.98,3.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 25 mg Cap [MDH],75981,CDM,,,0637,RC,00591-5787-01,NDC,facility,inpatient,1,EA,,3.63,2.18,2.98,3.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CANNULA ANTERIOR CHAMBER 30G,3270804,CDM,,,0272,RC,,,facility,inpatient,,,,3.64,2.18,2.98,3.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlordiazePOXIDE 5 mg Cap [MDH],74585,CDM,,,0637,RC,51079-0374-20,NDC,facility,inpatient,1,EA,,3.64,2.18,2.98,3.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
losartan 50 mg Tab [MDH],79022,CDM,,,0637,RC,00904-6390-61,NDC,facility,inpatient,1,EA,,3.64,2.18,2.98,3.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 18FR 30CC,2064610,CDM,,,0272,RC,,,facility,inpatient,,,,3.65,2.19,2.99,3.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 22FR 30CC,2064615,CDM,,,0272,RC,,,facility,inpatient,,,,3.65,2.19,2.99,3.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 28FR 30CC,2064620,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.65,2.19,2.99,3.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
MEDIHONEY 2 X 2 DRESSING,5698181,CDM,,,0272,RC,,,facility,inpatient,,,,3.65,2.19,2.99,3.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 30 mg/mL Inj Sol  1 mL [MDH],70224,CDM,,,0636,RC,63323-0162-12,NDC,facility,inpatient,1,ML,,3.65,2.19,2.99,3.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
rOPINIRole 1 mg Tab [MDH],78008,CDM,,,0637,RC,68084-0311-01,NDC,facility,inpatient,1,EA,,3.65,2.19,2.99,3.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",2.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 14FR 30CC,2063604,CDM,A4338,CPT,0274,RC,,,facility,inpatient,,,,3.66,2.2,3,3.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 25 mg Tab [MDH],70064,CDM,,,0637,RC,68382-0022-01,NDC,facility,inpatient,1,EA,,3.66,2.2,3,3.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide-triamterene 12.5mg-18.75 mg (1/2) [MDH],71889,CDM,,,0637,RC,00781-1123-01A,NDC,facility,inpatient,1,EA,,3.66,2.2,3,3.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 112 mcg Tab,79978,CDM,,,0637,RC,60687-0508-01,NDC,facility,inpatient,1,EA,,3.66,2.2,3,3.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-511-G   5-0 VICRYL PL,3261207,CDM,,,0272,RC,,,facility,inpatient,,,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 20 mg Tab,70135,CDM,,,0637,RC,23155-0873-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 20 mg Tab [MDH],70135,CDM,,,0637,RC,31722-0531-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 20 mg Tab,70135,CDM,,,0637,RC,65862-0127-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
doxepin 25 mg Cap [MDH],70214,CDM,,,0637,RC,00378-3125-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.5 mg Tab,71808,CDM,,,0637,RC,51991-0705-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 25 mg-100 mg Tab,77067,CDM,,,0637,RC,60687-0661-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 25 mg-100 mg Tab [MDH],77067,CDM,,,0637,RC,68084-0093-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traMADol 50 mg Tab [MDH],79066,CDM,,,0636,RC,68084-0808-01,NDC,facility,inpatient,1,EA,,3.67,2.2,3.01,3.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE Z-371-T   1-0 PDS CTX,3223452,CDM,,,0272,RC,,,facility,inpatient,,,,3.68,2.21,3.02,3.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 125 mcg (0.125 mg) Tab,70095,CDM,,,0637,RC,00904-6955-61,NDC,facility,inpatient,1,EA,,3.68,2.21,3.02,3.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
misoprostol 100 mcg Tab [MDH],71389,CDM,,,0637,RC,59762-5007-01,NDC,facility,inpatient,1,EA,,3.68,2.21,3.02,3.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
miSOPROStol 100 mcg Tab,71389,CDM,,,0637,RC,59762-5007-02,NDC,facility,inpatient,1,EA,,3.68,2.21,3.02,3.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 100 mg Tab [MDH],74694,CDM,,,0637,RC,51079-0802-20,NDC,facility,inpatient,1,EA,,3.68,2.21,3.02,3.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
misoprostol 100 mcg Tab [MDH],71389,CDM,,,0637,RC,00172-4430-49,NDC,facility,inpatient,1,EA,,3.69,2.21,3.03,3.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Misoprostol 25 mcg tablet (1/4 tab) (MDH),71390,CDM,,,0637,RC,59762500710A,NDC,facility,inpatient,1,EA,,3.69,2.21,3.03,3.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traMADol 50 mg Tab,79066,CDM,,,0637,RC,00093-0058-01,NDC,facility,inpatient,1,EA,,3.69,2.21,3.03,3.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loratadine-pseudoePHEDrine 5 mg-120 mg ER Tab [MDH],79076,CDM,,,0637,RC,11523-7162-03,NDC,facility,inpatient,1,EA,,3.69,2.21,3.03,3.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traMADol 50 mg Tab,79066,CDM,,,0637,RC,60219-2348-01,NDC,facility,inpatient,1,EA,,3.7,2.22,3.03,3.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.33,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
torsemide 20 mg Tab [MDH],70135,CDM,,,0637,RC,68084-0539-01,NDC,facility,inpatient,1,EA,,3.71,2.23,3.04,3.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traMADol 50 mg Tab,79066,CDM,,,0637,RC,57664-0377-08,NDC,facility,inpatient,1,EA,,3.71,2.23,3.04,3.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
doxepin 25 mg Cap [MDH],70214,CDM,,,0637,RC,51079-0437-20,NDC,facility,inpatient,1,EA,,3.72,2.23,3.05,3.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PROLENE 5-0 PS-2 18 BLUE,3268509,CDM,,,0272,RC,,,facility,inpatient,,,,3.73,2.24,3.06,3.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
naproxen sodium 275 mg Tab [MDH],70523,CDM,,,0637,RC,00093-0536-01,NDC,facility,inpatient,1,EA,,3.73,2.24,3.06,3.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
azaTHIOprine 50 mg Tab [MDH],73940,CDM,,,0637,RC,68084-0229-01,NDC,facility,inpatient,1,EA,,3.73,2.24,3.06,3.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PHENobarbital 32.4 mg Tab [MDH],76320,CDM,,,0637,RC,63739-0201-10,NDC,facility,inpatient,1,EA,,3.73,2.24,3.06,3.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 50 mg Tab [MDH],77702,CDM,,,0637,RC,68382-0023-01,NDC,facility,inpatient,1,EA,,3.73,2.24,3.06,3.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 500 mg Oral DR Tab [MDH],71826,CDM,,,0636,RC,68084-0782-32,NDC,facility,inpatient,1,EA,,3.74,2.24,3.07,3.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
penicillin V potassium 250 mg Tab,74563,CDM,,,0637,RC,57237-0040-01,NDC,facility,inpatient,1,EA,,3.74,2.24,3.07,3.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hyoscyamine 0.125 mg Tab,78647,CDM,,,0637,RC,42192-0340-01,NDC,facility,inpatient,1,EA,,3.74,2.24,3.07,3.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hyoscyamine 0.125 mg Tab [MDH],78647,CDM,,,0637,RC,43199-0013-01,NDC,facility,inpatient,1,EA,,3.74,2.24,3.07,3.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meclizine 25 mg Tab [MDH],70560,CDM,,,0637,RC,68084-0491-01,NDC,facility,inpatient,1,EA,,3.75,2.25,3.08,3.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg Tab,71385,CDM,,,0637,RC,70010-0491-01,NDC,facility,inpatient,1,EA,,3.75,2.25,3.08,3.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 2.5 mg Tab,71429,CDM,,,0637,RC,50268-0083-15,NDC,facility,inpatient,1,EA,,3.75,2.25,3.08,3.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VACURETTE CURVED 12MM,CDM,CDM,,,0272,RC,,,facility,inpatient,,,,3.75,2.25,3.08,3.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meclizine 25 mg Tab [MDH],70560,CDM,,,0637,RC,51079-0090-20,NDC,facility,inpatient,1,EA,,3.76,2.26,3.08,3.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atorvastatin 40 mg Tab UD[MDH] *,71346,CDM,,,0250,RC,68084-0099-01,NDC,facility,inpatient,1,EA,,3.76,2.26,3.08,3.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atorvastatin 20 mg Tab UD[MDH],71794,CDM,,,0636,RC,68084-0098-01,NDC,facility,inpatient,1,EA,,3.76,2.26,3.08,3.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DUAL LUMEN STOMACH TUBE 10FR X 36,3104100,CDM,,,0272,RC,,,facility,inpatient,,,,3.78,2.27,3.1,3.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 10 mg/mL IV Sol 2mL [MDH],70176,CDM,,,0636,RC,63323-0739-12,NDC,facility,inpatient,2,ML,,3.78,2.27,3.1,3.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg/mL Inj Sol 2 mL [MDH],76765,CDM,,,0636,RC,00703-4502-94,NDC,facility,inpatient,2,ML,,3.78,2.27,3.1,3.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 30FR 30CC,2064701,CDM,,,0272,RC,,,facility,inpatient,,,,3.79,2.27,3.11,3.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CONVAFOAM ADH SIL MULTI 5.5 X 7.8IN,5697181,CDM,A6210,CPT,0272,RC,,,facility,inpatient,,,,3.79,2.27,3.11,3.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 10 mg/mL IV Sol 2mL [MDH],70176,CDM,,,0636,RC,00641-6022-25,NDC,facility,inpatient,2,ML,,3.79,2.27,3.11,3.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fenofibrate 48 mg Tab [MDH],70388,CDM,,,0637,RC,51079-0599-01,NDC,facility,inpatient,1,EA,,3.79,2.27,3.11,3.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 5 mg Tab,76578,CDM,,,0637,RC,60687-0667-01,NDC,facility,inpatient,1,EA,,3.79,2.27,3.11,3.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 5 mg Tab [MDH],76578,CDM,,,0637,RC,68084-0196-01,NDC,facility,inpatient,1,EA,,3.79,2.27,3.11,3.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 25 mg-100 mg Tab,77067,CDM,,,0637,RC,00093-9702-01,NDC,facility,inpatient,1,EA,,3.79,2.27,3.11,3.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loperamide 2 mg Cap [MDH],73935,CDM,,,0637,RC,51079-0690-20,NDC,facility,inpatient,1,EA,,3.8,2.28,3.12,3.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atropine-diphenoxylate 0.025 mg-2.5 mg Tab [MDH],74690,CDM,,,0637,RC,00378-0415-01,NDC,facility,inpatient,1,EA,,3.8,2.28,3.12,3.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 150 mcg (0.15 mg) Tab,77540,CDM,,,0637,RC,60687-0530-01,NDC,facility,inpatient,1,EA,,3.8,2.28,3.12,3.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHOE POST-OP MEN MEDIUM,2218505,CDM,,,0270,RC,,,facility,inpatient,,,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHOE POST-OP MEN LARGE,2219008,CDM,,,0270,RC,,,facility,inpatient,,,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHOE POST-OP WOMEN SMALL,2221004,CDM,,,0270,RC,,,facility,inpatient,,,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHOE POST-OP WOMEN MEDIUM,2221509,CDM,,,0270,RC,,,facility,inpatient,,,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHOE POST-OP WOMEN LARGE,2222002,CDM,,,0270,RC,,,facility,inpatient,,,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glimepiride 2 mg Tab [MDH],70253,CDM,,,0637,RC,68084-0326-01,NDC,facility,inpatient,1,EA,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 25 mg Cap,75981,CDM,,,0637,RC,60687-0293-01,NDC,facility,inpatient,1,EA,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 25 mg Cap [MDH],75981,CDM,,,0637,RC,68084-0032-01,NDC,facility,inpatient,1,EA,,3.82,2.29,3.13,3.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J-594-G   4-0 VICRYL PS,3171901,CDM,,,0272,RC,,,facility,inpatient,,,,3.83,2.3,3.14,3.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1966-G    6-0 ETHIL. BK,3260209,CDM,,,0272,RC,,,facility,inpatient,,,,3.83,2.3,3.14,3.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-7.5 mg Tab [MDH],71771,CDM,,,0637,RC,00406-0124-62,NDC,facility,inpatient,1,EA,,3.83,2.3,3.14,3.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 500 mg Tab [MDH],75247,CDM,,,0637,RC,68084-0051-01,NDC,facility,inpatient,1,EA,,3.83,2.3,3.14,3.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nitroglycerin 2.5 mg Cap,75660,CDM,,,0637,RC,49483-0221-10,NDC,facility,inpatient,1,EA,,3.83,2.3,3.14,3.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
TUOHY EPIDURAL NEEDLE 16G 3-1/2,2136820,CDM,,,0272,RC,,,facility,inpatient,,,,3.84,2.3,3.15,3.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHOE POST-OP MEN X-LARGE,2220005,CDM,,,0270,RC,,,facility,inpatient,,,,3.84,2.3,3.15,3.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 50 mg Tab [MDH],77702,CDM,,,0637,RC,51079-0684-20,NDC,facility,inpatient,1,EA,,3.84,2.3,3.15,3.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Warfarin 0.5 mg tab (1/2) [MDH],71892,CDM,,,0637,RC,00560-0169-01A,NDC,facility,inpatient,1,EA,,3.85,2.31,3.16,3.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prazosin 1 mg Cap,75145,CDM,,,0637,RC,59651-0271-01,NDC,facility,inpatient,1,EA,,3.85,2.31,3.16,3.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ondansetron 2 mg/mL Sol,79008,CDM,,,0636,RC,36000-0012-25,NDC,facility,inpatient,2,ML,,3.85,2.31,3.16,3.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
AQUACEL FOAM ADHESIVE 4 X 12,5697070,CDM,,,0270,RC,,,facility,inpatient,,,,3.86,2.32,3.17,3.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfaSALAzine 500 mg Tab,70920,CDM,,,0637,RC,62135-0960-01,NDC,facility,inpatient,1,EA,,3.86,2.32,3.17,3.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acarbose 25 mg Tab [MDH],71621,CDM,,,0637,RC,23155-0147-01,NDC,facility,inpatient,1,EA,,3.86,2.32,3.17,3.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acarbose 25 mg Tab [MDH],71621,CDM,,,0637,RC,64380-0758-06,NDC,facility,inpatient,1,EA,,3.86,2.32,3.17,3.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propylthiouracil 50 mg Tab [MDH],76660,CDM,,,0637,RC,00228-2348-10,NDC,facility,inpatient,1,EA,,3.86,2.32,3.17,3.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propylthiouracil 50 mg Tab [MDH],76660,CDM,,,0637,RC,67253-0651-10,NDC,facility,inpatient,1,EA,,3.86,2.32,3.17,3.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg Tab,70007,CDM,,,0637,RC,51079-0886-20,NDC,facility,inpatient,1,EA,,3.87,2.32,3.17,3.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zonisamide 100 mg Cap,71121,CDM,,,0637,RC,60687-0230-01,NDC,facility,inpatient,1,EA,,3.87,2.32,3.17,3.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pregabalin 50 mg Cap,71372,CDM,,,0637,RC,00904-6992-61,NDC,facility,inpatient,1,EA,,3.87,2.32,3.17,3.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
QUEtiapine 50 mg Tab,71822,CDM,,,0637,RC,00904-6801-61,NDC,facility,inpatient,1,EA,,3.87,2.32,3.17,3.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glyBURIDE 5 mg Tab [MDH],72541,CDM,,,0637,RC,68084-0807-01,NDC,facility,inpatient,1,EA,,3.87,2.32,3.17,3.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHOE POST-OP MEN SMALL,2218000,CDM,,,0270,RC,,,facility,inpatient,,,,3.88,2.33,3.18,3.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  691-G    4-0 ETHILON,3161704,CDM,,,0272,RC,,,facility,inpatient,,,,3.88,2.33,3.18,3.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
morphine 15 mg Tab [MDH],46490,CDM,,,0250,RC,00054-0235-24,NDC,facility,inpatient,1,EA,,3.88,2.33,3.18,3.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 5 mg Tab [MDH],76578,CDM,,,0637,RC,51079-0981-20,NDC,facility,inpatient,1,EA,,3.89,2.33,3.19,3.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrOXYzine hydrochloride 25 mg Tab,70811,CDM,,,0637,RC,23155-0501-01,NDC,facility,inpatient,1,EA,,3.9,2.34,3.2,3.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.51,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 24FR 30CC,2064206,CDM,A4338,CPT,0274,RC,,,facility,inpatient,,,,3.91,2.35,3.21,3.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 26FR 30CC,2064305,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,3.91,2.35,3.21,3.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 7.5 mg Tab,72140,CDM,,,0637,RC,00832-1218-01,NDC,facility,inpatient,1,EA,,3.91,2.35,3.21,3.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SORBACT DRESSING 7/9 COMPRESS,5696818,CDM,,,0272,RC,,,facility,inpatient,,,,3.94,2.36,3.23,3.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.5 mg Tab *,71808,CDM,,,0637,RC,00228-2029-10,NDC,facility,inpatient,1,EA,,3.94,2.36,3.23,3.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ALPRAZolam 0.5 mg Tab,71808,CDM,,,0637,RC,65862-0677-01,NDC,facility,inpatient,1,EA,,3.94,2.36,3.23,3.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING SM LNG THIGH A-E,2114506,CDM,,,0270,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING MED SH THIGH A-E,2115008,CDM,,,0270,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING MED REG THIGH A-E,2115503,CDM,,,0270,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING MED LG THIGH A-E,2116006,CDM,,,0270,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING LRG SH THIGH A-E,2116501,CDM,,,0270,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING LRG LG THIGH A-E,2117509,CDM,,,0270,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING X-LARGE LONG THIGH,5692121,CDM,,,0272,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING XX-LRG REG THIGH,5692212,CDM,,,0270,RC,,,facility,inpatient,,,,3.95,2.37,3.24,3.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thyroid desiccated 30 mg Tab,77960,CDM,,,0637,RC,42192-0329-01,NDC,facility,inpatient,1,EA,,3.96,2.38,3.25,3.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
allopurinol 300 mg Tab,78715,CDM,,,0637,RC,60687-0688-01,NDC,facility,inpatient,1,EA,,3.96,2.38,3.25,3.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
allopurinol 300 mg Tab [MDH],78715,CDM,,,0637,RC,62584-0713-01,NDC,facility,inpatient,1,EA,,3.96,2.38,3.25,3.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.76,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING SMALL SHORT THIGH A-E,2113508,CDM,,,0270,RC,,,facility,inpatient,,,,3.97,2.38,3.26,3.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bacitracin/neomycin/polymyxin B topical 400 units-3.5 mg-5000 units/g Oin U/D [MDH],72002,CDM,,,0637,RC,45802-0143-70,NDC,facility,inpatient,1,EA,,3.97,2.38,3.26,3.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bacitracin/neomycin/polymyxin B topical 400 units-3.5 mg-5000 units/g Oin,72002,CDM,,,0637,RC,47682-0223-35,NDC,facility,inpatient,1,EA,,3.97,2.38,3.26,3.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 10 mg Tab [MDH],76579,CDM,,,0637,RC,51079-0982-20,NDC,facility,inpatient,1,EA,,3.97,2.38,3.26,3.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 25 mg-250 mg Tab [MDH],77070,CDM,,,0637,RC,68084-0094-01,NDC,facility,inpatient,1,EA,,3.97,2.38,3.26,3.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-codeine 300 mg-30 mg Tab,46820,CDM,,,0637,RC,00406-0484-03,NDC,facility,inpatient,1,EA,,3.98,2.39,3.26,3.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
primidone 250 mg Tab [MDH],75350,CDM,,,0637,RC,68084-0203-01,NDC,facility,inpatient,1,EA,,3.98,2.39,3.26,3.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dipyridamole 25 mg Tab [MDH],76200,CDM,,,0637,RC,00054-0434-25,NDC,facility,inpatient,1,EA,,3.98,2.39,3.26,3.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BELT RIB WOMEN UNIVERSAL,2041006,CDM,,,0272,RC,,,facility,inpatient,,,,3.99,2.39,3.27,3.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SENI-CARE PROTECTIVE BARRIER,2132102,CDM,,,0270,RC,,,facility,inpatient,,,,3.99,2.39,3.27,3.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fluorescein ophthalmic 1 mg Tes,72101,CDM,,,0636,RC,83851-0100-30,NDC,facility,inpatient,1,EA,,3.99,2.39,3.27,3.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 7.5 mg Tab,72140,CDM,,,0637,RC,65162-0768-10,NDC,facility,inpatient,1,EA,,3.99,2.39,3.27,3.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prazosin 1 mg Cap,75145,CDM,,,0637,RC,00093-4067-01,NDC,facility,inpatient,1,EA,,3.99,2.39,3.27,3.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ondansetron 2 mg/mL Sol,79008,CDM,,,0636,RC,00641-6078-25,NDC,facility,inpatient,2,ML,,3.99,2.39,3.27,3.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ondansetron 2 mg/mL Inj Sol 2mL [MDH],79008,CDM,,,0636,RC,00641-6080-25,NDC,facility,inpatient,2,ML,,3.99,2.39,3.27,3.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 1824H  4-0  SC-1,3452121,CDM,,,0272,RC,,,facility,inpatient,,,,4,2.4,3.28,4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - DAY HEALTH TRANSPORTATION HL,62033,CDM,,,0930,RC,,,facility,inpatient,,,,4,2.4,3.28,4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-tramadol 325 mg-37.5 mg Tab [MDH],71428,CDM,,,0637,RC,50268-0774-15,NDC,facility,inpatient,1,EA,,4,2.4,3.28,4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-tramadol 325 mg-37.5 mg Tab [MDH],71428,CDM,,,0637,RC,68084-0496-01,NDC,facility,inpatient,1,EA,,4,2.4,3.28,4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-tramadol 325 mg-37.5 mg Tab [MDH],71428,CDM,,,0637,RC,68084-0825-01,NDC,facility,inpatient,1,EA,,4,2.4,3.28,4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 10 mg Tab [MDH],76775,CDM,,,0637,RC,51079-0888-20,NDC,facility,inpatient,1,EA,,4,2.4,3.28,4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
STOCKING  SMALL REGULAR THIGH A-E,2114001,CDM,,,0270,RC,,,facility,inpatient,,,,4.01,2.41,3.29,4.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cefTRIAXone 500 mg Inj [MDH],71135,CDM,,,0636,RC,00409-7338-01,NDC,facility,inpatient,1,EA,,4.01,2.41,3.29,4.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cefTRIAXone 500 mg Pow [MDH],71135,CDM,,,0636,RC,00409-7338-20,NDC,facility,inpatient,1,EA,,4.01,2.41,3.29,4.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BAG DRAINAGE 4000ML,2028102,CDM,,,0272,RC,,,facility,inpatient,,,,4.02,2.41,3.3,4.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BAG COLLECT FECAL FLEXI-SEAL,2100901,CDM,,,0270,RC,,,facility,inpatient,,,,4.02,2.41,3.3,4.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
colchicine-probenecid 0.5 mg-500 mg Tab [MDH],71870,CDM,,,0637,RC,00591-5325-01,NDC,facility,inpatient,1,EA,,4.02,2.41,3.3,4.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 5 mg Tab [MDH],73700,CDM,,,0637,RC,00781-1396-13,NDC,facility,inpatient,1,EA,,4.04,2.42,3.31,4.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ethambutol 400 mg Tab [MDH],75235,CDM,,,0637,RC,68850-0012-02,NDC,facility,inpatient,1,EA,,4.04,2.42,3.31,4.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bisacodyl 10 mg Supp [MDH],71285,CDM,,,0637,RC,00574-7050-50,NDC,facility,inpatient,1,EA,,4.05,2.43,3.32,4.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 1 mg/mL Inj Sol 2mL [MDH],78510,CDM,,,0636,RC,00409-2305-17,NDC,facility,inpatient,2,ML,,4.05,2.43,3.32,4.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BELT RIB MEN UNIVERSAL,2040503,CDM,,,0270,RC,,,facility,inpatient,,,,4.06,2.44,3.33,4.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
liothyronine 25 mcg Tab,72200,CDM,,,0637,RC,51407-0385-01,NDC,facility,inpatient,1,EA,,4.06,2.44,3.33,4.06,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.06,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-5 mg Tab [MDH],70138,CDM,,,0636,RC,50268-0401-15,NDC,facility,inpatient,1,EA,,4.09,2.45,3.35,4.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 100 mg Tab,70287,CDM,,,0637,RC,60687-0413-65,NDC,facility,inpatient,1,EA,,4.09,2.45,3.35,4.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
primidone 250 mg Tab,75350,CDM,,,0637,RC,00527-1231-01,NDC,facility,inpatient,1,EA,,4.09,2.45,3.35,4.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thyroid desiccated 30 mg Tab [MDH],77960,CDM,,,0637,RC,00456-0458-01,NDC,facility,inpatient,1,EA,,4.09,2.45,3.35,4.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 2-WAY ROUND TIP LUBRICATH 16FR 30CC,2063703,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,4.1,2.46,3.36,4.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER TROCAR 40FR,2072606,CDM,,,0270,RC,,,facility,inpatient,,,,4.1,2.46,3.36,4.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dilTIAZem 30 mg Tab,71517,CDM,,,0637,RC,00093-0318-01,NDC,facility,inpatient,1,EA,,4.1,2.46,3.36,4.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dilTIAZem 30 mg Tab,71517,CDM,,,0637,RC,68682-0006-10,NDC,facility,inpatient,1,EA,,4.1,2.46,3.36,4.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 600 mg ER Tab [MDH],71150,CDM,,,0637,RC,68084-0572-01,NDC,facility,inpatient,1,EA,,4.11,2.47,3.37,4.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  690-G    5-0 ETHILON,3161605,CDM,,,0272,RC,,,facility,inpatient,,,,4.12,2.47,3.38,4.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glimepiride 1 mg Tab,71436,CDM,,,0637,RC,68084-0788-25,NDC,facility,inpatient,1,EA,,4.12,2.47,3.38,4.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 1 mg/mL Sol,74693,CDM,,,0636,RC,72611-0740-10,NDC,facility,inpatient,5,ML,,4.12,2.47,3.38,4.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 20 mg Tab [MDH],70057,CDM,,,0637,RC,51079-0983-20,NDC,facility,inpatient,1,EA,,4.13,2.48,3.39,4.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VACURETTE CURVED  8MM,3241001,CDM,,,0272,RC,,,facility,inpatient,,,,4.14,2.48,3.39,4.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  786-G    6-0 SILK BLK,3152505,CDM,,,0272,RC,,,facility,inpatient,,,,4.15,2.49,3.4,4.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE G696G,3414141,CDM,,,0272,RC,,,facility,inpatient,,,,4.16,2.5,3.41,4.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 5 mg Tab,73700,CDM,,,0637,RC,00378-0327-01,NDC,facility,inpatient,1,EA,,4.16,2.5,3.41,4.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nitroglycerin 0.4 mg sublingual Tab [MDH],75680,CDM,,,0636,RC,59762-3304-03,NDC,facility,inpatient,1,EA,,4.16,2.5,3.41,4.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nitroglycerin 0.4 mg Tab,75680,CDM,,,0637,RC,68462-0639-45,NDC,facility,inpatient,1,EA,,4.16,2.5,3.41,4.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VACURETTE CURVED  9MM,CDM,CDM,,,0272,RC,,,facility,inpatient,,,,4.16,2.5,3.41,4.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.41,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 20 mg Tab [MDH],70057,CDM,,,0637,RC,68084-0198-11,NDC,facility,inpatient,1,EA,,4.17,2.5,3.42,4.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.42,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 10 mg/mL Sol,74540,CDM,,,0636,RC,71288-0203-03,NDC,facility,inpatient,2,ML,,4.2,2.52,3.44,4.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING ALLEVYN 6 X 6 SACRAL,2291603,CDM,,,0272,RC,,,facility,inpatient,,,,4.21,2.53,3.45,4.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 923-H 2-0 CHROMIC,3263005,CDM,,,0272,RC,,,facility,inpatient,,,,4.21,2.53,3.45,4.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
mirtazapine 15 mg Tab UD [MDH],71839,CDM,,,0637,RC,68084-0119-01,NDC,facility,inpatient,1,EA,,4.21,2.53,3.45,4.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ethyl chloride topical 100% Spr,71962,CDM,,,0250,RC,00386-0001-13,NDC,facility,inpatient,103.5,ML,,4.22,2.53,3.46,4.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
liothyronine 25 mcg Tab [MDH],72200,CDM,,,0637,RC,00574-0222-01,NDC,facility,inpatient,1,EA,,4.22,2.53,3.46,4.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loperamide 2 mg Cap,73935,CDM,,,0637,RC,00378-2100-01,NDC,facility,inpatient,1,EA,,4.22,2.53,3.46,4.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE  816-H    2-0 GUT CHR C,3159005,CDM,,,0272,RC,,,facility,inpatient,,,,4.23,2.54,3.47,4.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 25 mg ER Tab [MDH],70059,CDM,,,0637,RC,64679-0734-02,NDC,facility,inpatient,1,EA,,4.23,2.54,3.47,4.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 50 mg Tab,70164,CDM,,,0637,RC,68001-0469-00,NDC,facility,inpatient,1,EA,,4.23,2.54,3.47,4.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fludrocortisone 0.1 mg Tab [MDH],73363,CDM,,,0637,RC,68084-0288-01,NDC,facility,inpatient,1,EA,,4.23,2.54,3.47,4.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
quiNIDine 300 mg ER Tab [MDH],76755,CDM,,,0637,RC,00093-9175-01,NDC,facility,inpatient,1,EA,,4.23,2.54,3.47,4.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
naproxen 375 mg Tab [MDH],75406,CDM,,,0637,RC,68462-0189-01,NDC,facility,inpatient,1,EA,,4.24,2.54,3.48,4.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lisinopril 20 mg Tab,70057,CDM,,,0637,RC,68180-0981-01,NDC,facility,inpatient,1,EA,,4.25,2.55,3.48,4.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE J583G VICRYL 27,1338313,CDM,,,0272,RC,,,facility,inpatient,,,,4.26,2.56,3.49,4.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL STERILE WATER IRR 1000ML,3022609,CDM,,,0250,RC,,,facility,inpatient,,,,4.26,2.56,3.49,4.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyproheptadine 4 mg Tab,76150,CDM,,,0637,RC,52817-0210-10,NDC,facility,inpatient,1,EA,,4.26,2.56,3.49,4.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyproheptadine 4 mg Tab [MDH],76150,CDM,,,0637,RC,70710-1110-01,NDC,facility,inpatient,1,EA,,4.26,2.56,3.49,4.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NIFEdipine 10 mg Cap [MDH],76608,CDM,,,0637,RC,00228-2497-10,NDC,facility,inpatient,1,EA,,4.26,2.56,3.49,4.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NIFEdipine 10 mg Cap,76608,CDM,,,0637,RC,59762-1004-01,NDC,facility,inpatient,1,EA,,4.26,2.56,3.49,4.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NIFEdipine 10 mg Cap [MDH],76608,CDM,,,0637,RC,69315-0211-01,NDC,facility,inpatient,1,EA,,4.26,2.56,3.49,4.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HOLDER ENDO-TRACH LAERDAL THOMAS,2586606,CDM,,,0270,RC,,,facility,inpatient,,,,4.27,2.56,3.5,4.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 1 mg Tab,73690,CDM,,,0637,RC,00832-1520-11,NDC,facility,inpatient,1,EA,,4.27,2.56,3.5,4.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traZODone 50 mg Tab [MDH],72502,CDM,,,0637,RC,50111-0433-01,NDC,facility,inpatient,1,EA,,4.28,2.57,3.51,4.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
traZODone 50 mg Tab,72502,CDM,,,0637,RC,68382-0805-01,NDC,facility,inpatient,1,EA,,4.28,2.57,3.51,4.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SHILEY DISPOSABLE INNER CANNULA SZ 4 - 6.5MM,2310316,CDM,A4623,CPT,0272,RC,,,facility,inpatient,,,,4.29,2.57,3.52,4.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab,41436,CDM,,,0636,RC,50268-0190-15,NDC,facility,inpatient,1,EA,,4.3,2.58,3.53,4.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
COLLAR CERVI-FOAM LARGE,2078503,CDM,,,0272,RC,,,facility,inpatient,,,,4.32,2.59,3.54,4.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LACERATION TRAY,2249014,CDM,,,0272,RC,,,facility,inpatient,,,,4.32,2.59,3.54,4.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bumetanide 1 mg Tab,71379,CDM,,,0637,RC,00185-0129-01,NDC,facility,inpatient,1,EA,,4.32,2.59,3.54,4.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 5 mg Tab [MDH],73700,CDM,,,0637,RC,51079-0736-20,NDC,facility,inpatient,1,EA,,4.32,2.59,3.54,4.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 800 mg-160 mg Tab [MDH],78046,CDM,,,0637,RC,53489-0146-01,NDC,facility,inpatient,1,EA,,4.32,2.59,3.54,4.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
naproxen 375 mg Tab [MDH],75406,CDM,,,0637,RC,51079-0794-20,NDC,facility,inpatient,1,EA,,4.33,2.6,3.55,4.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-10 mg Tab [MDH],70140,CDM,,,0636,RC,60687-0418-01,NDC,facility,inpatient,1,EA,,4.34,2.6,3.56,4.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 50 mg Tab,70164,CDM,,,0637,RC,50268-0541-15,NDC,facility,inpatient,1,EA,,4.34,2.6,3.56,4.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
TUBING DIGITAL DIGITUBE GE/KNIT/MIN OIL 3/4X6,2221069,CDM,,,0270,RC,,,facility,inpatient,,,,4.35,2.61,3.57,4.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE CHROMIC SZ1 36 CTX,3261717,CDM,,,0272,RC,,,facility,inpatient,,,,4.35,2.61,3.57,4.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroxyurea 500 mg Cap [MDH],73819,CDM,,,0637,RC,68084-0284-01,NDC,facility,inpatient,1,EA,,4.35,2.61,3.57,4.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SPLINT TOE UNIV 1 SZ SINGLE BUDIN,2221053,CDM,,,0270,RC,,,facility,inpatient,,,,4.37,2.62,3.58,4.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
liothyronine 25 mcg Tab,72200,CDM,,,0637,RC,42794-0019-12,NDC,facility,inpatient,1,EA,,4.37,2.62,3.58,4.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab,41436,CDM,,,0636,RC,68084-0753-25,NDC,facility,inpatient,1,EA,,4.38,2.63,3.59,4.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 25 mg Tab,70059,CDM,,,0636,RC,60687-0390-01,NDC,facility,inpatient,1,EA,,4.38,2.63,3.59,4.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 25 mg ER Tab [MDH],70059,CDM,,,0637,RC,68084-0659-01,NDC,facility,inpatient,1,EA,,4.38,2.63,3.59,4.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol succinate 50 mg ER Tab [MDH],70164,CDM,,,0637,RC,68084-0666-01,NDC,facility,inpatient,1,EA,,4.38,2.63,3.59,4.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide mononitrate 30 mg ER Tab [MDH],70231,CDM,,,0637,RC,00143-2230-01,NDC,facility,inpatient,1,EA,,4.38,2.63,3.59,4.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide mononitrate 30 mg Tab,70231,CDM,,,0637,RC,23155-0519-01,NDC,facility,inpatient,1,EA,,4.38,2.63,3.59,4.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carBAMazepine 200 mg Tab,77685,CDM,,,0250,RC,00904-6172-61,NDC,facility,inpatient,1,EA,,4.39,2.63,3.6,4.39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.39,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.17,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 120 mg Sup,78303,CDM,,,0637,RC,45802-0732-33,NDC,facility,inpatient,1,EA,,4.4,2.64,3.61,4.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loratadine-pseudoePHEDrine 5 mg-120 mg ER Tab [MDH],79076,CDM,,,0637,RC,45802-0106-60,NDC,facility,inpatient,1,EA,,4.4,2.64,3.61,4.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loratadine-pseudoephedrine 5 mg-120 mg Tab,79076,CDM,,,0637,RC,45802-0122-60,NDC,facility,inpatient,1,EA,,4.4,2.64,3.61,4.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atenolol 50 mg Tab [MDH],77702,CDM,,,0637,RC,62584-0467-01,NDC,facility,inpatient,1,EA,,4.41,2.65,3.62,4.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BLANKET WARMING UPPER BODY,3108304,CDM,,,0270,RC,,,facility,inpatient,,,,4.42,2.65,3.62,4.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
BLANKET WARMING FULL BODY,3108901,CDM,,,0270,RC,,,facility,inpatient,,,,4.42,2.65,3.62,4.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
labetalol 200 mg Tab [MDH],75741,CDM,,,0637,RC,00172-4365-60,NDC,facility,inpatient,1,EA,,4.42,2.65,3.62,4.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE Y-493-G MONOCRYL 3-P,3209206,CDM,,,0272,RC,,,facility,inpatient,,,,4.43,2.66,3.63,4.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,3.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE PROLENE 3-0 PC-5 18 8632G,3453131,CDM,,,0272,RC,,,facility,inpatient,,,,4.44,2.66,3.64,4.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HIGH FLOW ADULT CANNULA VAPOTHERM,5601614,CDM,,,0270,RC,,,facility,inpatient,,,,4.45,2.67,3.65,4.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 10 mg-100 mg Tab [MDH],77065,CDM,,,0637,RC,63739-0046-10,NDC,facility,inpatient,1,EA,,4.45,2.67,3.65,4.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY SILASTIC LATEX 24FR 5CC,2067360,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,4.46,2.68,3.66,4.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus,75573,CDM,,,0637,RC,65862-0496-47,NDC,facility,inpatient,473,ML,,4.46,2.68,3.66,4.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.66,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SPLINT TOE UNIV 1 SZ DOUBLE BUDIN,2221052,CDM,,,0270,RC,,,facility,inpatient,,,,4.47,2.68,3.67,4.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 800 mg-160 mg Tab,78046,CDM,,,0637,RC,65862-0420-01,NDC,facility,inpatient,1,EA,,4.47,2.68,3.67,4.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DUODERM SIGNAL 15X18,2092500,CDM,,,0270,RC,,,facility,inpatient,,,,4.48,2.69,3.67,4.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diphenhydrAMINE 50 mg/mL Inj Sol 1 mL [MDH],71070,CDM,,,0636,RC,00641-0376-25,NDC,facility,inpatient,1,ML,,4.48,2.69,3.67,4.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING MELGISORB AG 4 X 4,2227212,CDM,,,0272,RC,,,facility,inpatient,,,,4.49,2.69,3.68,4.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ANKLE SUPPORT LG #2004,2221088,CDM,,,0270,RC,,,facility,inpatient,,,,4.5,2.7,3.69,4.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ANKLE SUPPORT X-LG #2004,2221113,CDM,,,0270,RC,,,facility,inpatient,,,,4.5,2.7,3.69,4.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE L-113-G   2-0 GUT CHR,3134008,CDM,,,0272,RC,,,facility,inpatient,,,,4.5,2.7,3.69,4.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PROLENE 3-0 PS-2 18 BLUE,3458101,CDM,,,0272,RC,,,facility,inpatient,,,,4.5,2.7,3.69,4.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
atropine-diphenoxylate 0.025 mg-2.5 mg Tab,74690,CDM,,,0637,RC,60687-0569-01,NDC,facility,inpatient,1,EA,,4.5,2.7,3.69,4.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VACURETTE CURVED 10MM,CDM,CDM,,,0272,RC,,,facility,inpatient,,,,4.5,2.7,3.69,4.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE SURGICAL GUT 2-0 1 X 54 LIGAPAK REEL,3136015,CDM,,,0272,RC,,,facility,inpatient,,,,4.53,2.72,3.71,4.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.53,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg Tab [MDH],79500,CDM,,,0637,RC,00087-6060-05,NDC,facility,inpatient,1,EA,,4.54,2.72,3.72,4.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL STERILE WATER IRR  500ML,3022005,CDM,,,0250,RC,,,facility,inpatient,,,,4.55,2.73,3.73,4.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 4 mg Tab,72380,CDM,,,0637,RC,00054-4184-25,NDC,facility,inpatient,1,EA,,4.55,2.73,3.73,4.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 4 mg Tab,72380,CDM,,,0637,RC,47781-0914-01,NDC,facility,inpatient,1,EA,,4.55,2.73,3.73,4.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
thiothixene 1 mg Cap [MDH],77026,CDM,,,0637,RC,00378-1001-01,NDC,facility,inpatient,1,EA,,4.55,2.73,3.73,4.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clindamycin 150 mg Cap [MDH],71775,CDM,,,0637,RC,59762-3328-01,NDC,facility,inpatient,1,EA,,4.56,2.74,3.74,4.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PHENobarbital 97.2 mg Tab [MDH],76330,CDM,,,0637,RC,00603-5168-21,NDC,facility,inpatient,1,EA,,4.56,2.74,3.74,4.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.33,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRAIN SUCTION FLAT 10MM X 20MM,3176405,CDM,,,0272,RC,,,facility,inpatient,,,,4.57,2.74,3.75,4.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE R-552-H   3-0 MERSILE,3264706,CDM,,,0272,RC,,,facility,inpatient,,,,4.58,2.75,3.76,4.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
miSOPROStol 200 mcg Soln,72302,CDM,,,0637,RC,59762-5008-01,NDC,facility,inpatient,1,EA,,4.58,2.75,3.76,4.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
miSOPROStol 200 mcg Tab,78725,CDM,,,0637,RC,59762-5008-01,NDC,facility,inpatient,1,EA,,4.58,2.75,3.76,4.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
misoprostol 200 mcg Tab [MDH],78725,CDM,,,0637,RC,59762-5008-02,NDC,facility,inpatient,1,EA,,4.58,2.75,3.76,4.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 850 mg Tab,70260,CDM,,,0637,RC,60687-0143-01,NDC,facility,inpatient,1,EA,,4.59,2.75,3.76,4.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 850 mg Tab [MDH],70260,CDM,,,0637,RC,62584-0332-01,NDC,facility,inpatient,1,EA,,4.59,2.75,3.76,4.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dexamethasone 4 mg Tab [MDH],72380,CDM,,,0637,RC,00054-8175-25,NDC,facility,inpatient,1,EA,,4.59,2.75,3.76,4.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlorproPAMIDE 100 mg Tab [MDH],72535,CDM,,,0637,RC,00378-0197-01,NDC,facility,inpatient,1,EA,,4.59,2.75,3.76,4.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlorthalidone 25 mg Tab,73851,CDM,,,0637,RC,67877-0696-01,NDC,facility,inpatient,1,EA,,4.59,2.75,3.76,4.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
WAFER 1 3/4 SUR-FIT NATURA CONVEX 404592,2561010,CDM,,,0270,RC,,,facility,inpatient,,,,4.6,2.76,3.77,4.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PROLENE 4-0 PS-2 18 BLUE,3170408,CDM,,,0272,RC,,,facility,inpatient,,,,4.6,2.76,3.77,4.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-HYDROcodone 325 mg-10 mg Tab [MDH],70140,CDM,,,0636,RC,00406-0125-62,NDC,facility,inpatient,1,EA,,4.6,2.76,3.77,4.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midodrine 2.5 mg Tab [MDH],72249,CDM,,,0636,RC,60505-1320-01,NDC,facility,inpatient,1,EA,,4.6,2.76,3.77,4.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlorthalidone 25 mg Tab [MDH],73851,CDM,,,0637,RC,00378-0222-01,NDC,facility,inpatient,1,EA,,4.6,2.76,3.77,4.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlorthalidone 25 mg Tab [MDH],73851,CDM,,,0637,RC,64980-0303-01,NDC,facility,inpatient,1,EA,,4.6,2.76,3.77,4.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DRESSING MEPILEX TRANSFER 6 X 8 EXUDATE,5697919,CDM,A6210,CPT,0272,RC,,,facility,inpatient,,,,4.61,2.77,3.78,4.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ethyl chloride - FINE POINT topical 100% Spr [MDH],71962,CDM,,,0250,RC,00386-0001-04,NDC,facility,inpatient,103.5,ML,,4.61,2.77,3.78,4.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 10 mg-100 mg Tab [MDH],77065,CDM,,,0637,RC,00904-7718-61,NDC,facility,inpatient,1,EA,,4.61,2.77,3.78,4.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol tartrate 5 mg/5 mL (1 mg/mL) Inj Sol 5 mL [MDH],74693,CDM,,,0636,RC,00409-1778-05,NDC,facility,inpatient,5,ML,,4.62,2.77,3.79,4.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CREST PAD HAMMER TOE DELUXE SUEDE LG RT,2221010,CDM,,,0270,RC,,,facility,inpatient,,,,4.63,2.78,3.8,4.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CREST PAD HAMMER TOE DELUXE SUEDE SM LT,2221013,CDM,,,0270,RC,,,facility,inpatient,,,,4.63,2.78,3.8,4.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CREST PAD HAMMER TOE DELUXE SUEDE SM RT,2221014,CDM,,,0270,RC,,,facility,inpatient,,,,4.63,2.78,3.8,4.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 240 mg ER Tab [MDH],71439,CDM,,,0637,RC,51079-0869-19,NDC,facility,inpatient,1,EA,,4.63,2.78,3.8,4.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 400 mg Cap [MDH],71552,CDM,,,0637,RC,68084-0774-01,NDC,facility,inpatient,1,EA,,4.63,2.78,3.8,4.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE R-690-G   5-0 MERSILENE,3152000,CDM,,,0272,RC,,,facility,inpatient,,,,4.64,2.78,3.8,4.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VACURETTE CURVED 14MM 1/2 BASE,3242015,CDM,,,0272,RC,,,facility,inpatient,,,,4.64,2.78,3.8,4.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8523-H  2-0 PROLENE SH,3258402,CDM,,,0272,RC,,,facility,inpatient,,,,4.65,2.79,3.81,4.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHILON 5-0 P-3 18 BLACK,3414616,CDM,,,0272,RC,,,facility,inpatient,,,,4.65,2.79,3.81,4.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glimepiride 2 mg Tab [MDH],70253,CDM,,,0637,RC,51079-0425-20,NDC,facility,inpatient,1,EA,,4.65,2.79,3.81,4.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
silver sulfADIAZINE topical 1% Cre [MDH],71981,CDM,,,0637,RC,67877-0124-25,NDC,facility,inpatient,25,GM,,4.65,2.79,3.81,4.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHILON 6-0 P-3 18 BLACK,3414717,CDM,,,0272,RC,,,facility,inpatient,,,,4.66,2.8,3.82,4.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CREST PAD HAMMER TOE DELUXE SUEDE LG LT,2221009,CDM,,,0270,RC,,,facility,inpatient,,,,4.67,2.8,3.83,4.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CREST PAD HAMMER TOE DELUXE SUEDE MED RT,2221012,CDM,,,0270,RC,,,facility,inpatient,,,,4.67,2.8,3.83,4.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fentaNYL 0.05 mg/mL Inj Sol 2mL [MDH],46765,CDM,,,0636,RC,00409-9094-22,NDC,facility,inpatient,2,ML,,4.67,2.8,3.83,4.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
trandolapril 1 mg Tab,70381,CDM,,,0637,RC,57237-0089-01,NDC,facility,inpatient,1,EA,,4.67,2.8,3.83,4.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
trandolapril 1 mg Tab [MDH],70381,CDM,,,0637,RC,68180-0566-01,NDC,facility,inpatient,1,EA,,4.67,2.8,3.83,4.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
baclofen 5 mg Tab [MDH],72293,CDM,,,0637,RC,70710-1609-01,NDC,facility,inpatient,1,EA,,4.67,2.8,3.83,4.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 500 mg Tab,75247,CDM,,,0637,RC,50228-0465-01,NDC,facility,inpatient,1,EA,,4.67,2.8,3.83,4.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.97,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
betaxolol 10 mg Tab [MDH],71843,CDM,,,0637,RC,10702-0013-01,NDC,facility,inpatient,1,EA,,4.68,2.81,3.84,4.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.84,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CONVAFOAM ADH SIL SCRL SM,5697515,CDM,A6214,CPT,0270,RC,,,facility,inpatient,,,,4.69,2.81,3.85,4.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gentamicin 40 mg/mL Inj Sol 2 mL [MDH],73510,CDM,,,0636,RC,00409-1207-03,NDC,facility,inpatient,2,ML,,4.69,2.81,3.85,4.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg/mL Inj Sol 2 mL [MDH],76765,CDM,,,0636,RC,00409-3414-01,NDC,facility,inpatient,2,ML,,4.69,2.81,3.85,4.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,3.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 30 mg/mL Sol,70224,CDM,,,0636,RC,72611-0722-25,NDC,facility,inpatient,1,ML,,4.7,2.82,3.85,4.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide dinitrate 10 mg Tab [MDH],74180,CDM,,,0637,RC,68084-0082-01,NDC,facility,inpatient,1,EA,,4.7,2.82,3.85,4.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VERTICAL DRAIN/TUBE ATTACHMENT,2551015,CDM,,,0272,RC,,,facility,inpatient,,,,4.71,2.83,3.86,4.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CREST PAD HAMMER TOE DELUXE SUEDE MED LT,2221011,CDM,,,0270,RC,,,facility,inpatient,,,,4.72,2.83,3.87,4.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROcodone-ibuprofen 7.5 mg-200 mg Tab [MDH],70346,CDM,,,0637,RC,68084-0227-01,NDC,facility,inpatient,1,EA,,4.72,2.83,3.87,4.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROcodone-ibuprofen 7.5 mg-200 mg Tab [MDH],70346,CDM,,,0250,RC,68084-0841-01,NDC,facility,inpatient,1,EA,,4.72,2.83,3.87,4.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 25 mg Tab,70059,CDM,,,0636,RC,72516-0030-01,NDC,facility,inpatient,1,EA,,4.73,2.84,3.88,4.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loxapine 10 mg Cap [MDH],71159,CDM,,,0637,RC,00591-0370-01,NDC,facility,inpatient,1,EA,,4.75,2.85,3.89,4.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
loxapine 10 mg Cap [MDH],71159,CDM,,,0637,RC,51079-0901-20,NDC,facility,inpatient,1,EA,,4.75,2.85,3.89,4.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cholecalciferol 400 intl units/mL Liq 50 mL [MDH],71792,CDM,,,0637,RC,54838-0006-50,NDC,facility,inpatient,50,ML,,4.75,2.85,3.89,4.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bisacodyl 10 mg Sup,71285,CDM,,,0637,RC,00574-7050-12,NDC,facility,inpatient,1,EA,,4.76,2.86,3.9,4.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcitriol 0.25 mcg Cap[MDH],71936,CDM,,,0637,RC,00054-0007-13,NDC,facility,inpatient,1,EA,,4.77,2.86,3.91,4.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
calcitriol 0.25 mcg Cap,71936,CDM,,,0637,RC,69452-0207-13,NDC,facility,inpatient,1,EA,,4.77,2.86,3.91,4.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroxyurea 500 mg Cap [MDH],73819,CDM,,,0637,RC,49884-0724-01,NDC,facility,inpatient,1,EA,,4.77,2.86,3.91,4.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
doxycycline monohydrate 100 mg Cap,78520,CDM,,,0637,RC,68084-0743-21,NDC,facility,inpatient,1,EA,,4.77,2.86,3.91,4.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SOL SOD CHL IRR 500ML,3020702,CDM,,,0250,RC,,,facility,inpatient,,,,4.79,2.87,3.93,4.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8522-H    3-0 PROLENE S,3257700,CDM,,,0272,RC,,,facility,inpatient,,,,4.79,2.87,3.93,4.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isoniazid 300 mg Tab [MDH],74075,CDM,,,0637,RC,51079-0083-20,NDC,facility,inpatient,1,EA,,4.79,2.87,3.93,4.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.93,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SURESAMPLE ENDOMETRIAL SAMPLER,5691505,CDM,,,0270,RC,,,facility,inpatient,,,,4.8,2.88,3.94,4.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.56,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
EVACUATOR CLOSED WOUND 100ML RELIAVAC,3176504,CDM,,,0272,RC,,,facility,inpatient,,,,4.81,2.89,3.94,4.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin adult Sup,73645,CDM,,,0637,RC,00713-0101-25,NDC,facility,inpatient,1,EA,,4.81,2.89,3.94,4.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 500 mg Tab [MDH],75247,CDM,,,0637,RC,00093-1015-01,NDC,facility,inpatient,1,EA,,4.81,2.89,3.94,4.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.57,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
RECOMMENDED TO USE 5695940 - MEPITEL AG 4 X 7,5699414,CDM,,,0272,RC,,,facility,inpatient,,,,4.82,2.89,3.95,4.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 10 mg Tab,78340,CDM,,,0637,RC,60687-0689-01,NDC,facility,inpatient,1,EA,,4.82,2.89,3.95,4.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHILON 2-0 PS 18 BLACK,1306717,CDM,,,0272,RC,,,facility,inpatient,,,,4.83,2.9,3.96,4.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acyclovir 200 mg Cap [MDH],78713,CDM,,,0637,RC,68084-0107-01,NDC,facility,inpatient,1,EA,,4.84,2.9,3.97,4.84,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.84,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.97,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE W-31-G        BONE WAX,3239500,CDM,,,0272,RC,,,facility,inpatient,,,,4.85,2.91,3.98,4.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ondansetron 2 mg/mL Sol [MDH],79008,CDM,,,0636,RC,00409-4755-03,NDC,facility,inpatient,2,ML,,4.85,2.91,3.98,4.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ELECTRODE FETAL SCALP SPIRAL,2424103,CDM,,,0272,RC,,,facility,inpatient,,,,4.86,2.92,3.99,4.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",3.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ETHILON 3-0 PS-2 18 BLACK,3157504,CDM,,,0272,RC,,,facility,inpatient,,,,4.88,2.93,4,4.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloZAPine 25 mg Tab [MDH],71830,CDM,,,0637,RC,00093-4359-93,NDC,facility,inpatient,1,EA,,4.88,2.93,4,4.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cloZAPine 25 mg Tab,71830,CDM,,,0637,RC,51079-0921-20,NDC,facility,inpatient,1,EA,,4.88,2.93,4,4.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PRESSURE INFUSOR 1000CC,5694717,CDM,,,0272,RC,,,facility,inpatient,,,,4.91,2.95,4.03,4.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 180 mg/24 hours ERCap [MDH],75203,CDM,,,0637,RC,00378-5280-01,NDC,facility,inpatient,1,EA,,4.91,2.95,4.03,4.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NIFEdipine 30 mg ER Tab [MDH],78747,CDM,,,0637,RC,62175-0260-37,NDC,facility,inpatient,1,EA,,4.91,2.95,4.03,4.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.42,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VICRYL 3-0 PS-2 18 UNDYED,3429101,CDM,,,0272,RC,,,facility,inpatient,,,,4.92,2.95,4.03,4.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 300 mg Cap,70208,CDM,,,0636,RC,65162-0102-10,NDC,facility,inpatient,1,EA,,4.92,2.95,4.03,4.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 300 mg Cap,70208,CDM,,,0637,RC,65162-0102-50,NDC,facility,inpatient,1,EA,,4.92,2.95,4.03,4.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lovastatin 10 mg Tab [MDH],71594,CDM,,,0637,RC,00093-0926-06,NDC,facility,inpatient,1,EA,,4.93,2.96,4.04,4.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DUAL LUMEN STOMACH TUBE 18FR X 48,2299000,CDM,,,0272,RC,,,facility,inpatient,,,,4.94,2.96,4.05,4.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 300 mg Cap [MDH],70208,CDM,,,0637,RC,60505-0113-00,NDC,facility,inpatient,1,EA,,4.94,2.96,4.05,4.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide dinitrate 20 mg Tab [MDH],74167,CDM,,,0637,RC,68084-0083-01,NDC,facility,inpatient,1,EA,,4.94,2.96,4.05,4.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.69,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.05,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VICRYL 4-0 PS-2 18 UNDYED,3216607,CDM,,,0272,RC,,,facility,inpatient,,,,4.95,2.97,4.06,4.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE 8581-H    4-0 PROLENE B,3258203,CDM,,,0272,RC,,,facility,inpatient,,,,4.95,2.97,4.06,4.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glipiZIDE 2.5 mg ER Tab [MDH],71115,CDM,,,0637,RC,68084-0295-21,NDC,facility,inpatient,1,EA,,4.96,2.98,4.07,4.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.07,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
neomycin 500 mg Tab,75515,CDM,,,0637,RC,00093-1177-01,NDC,facility,inpatient,1,EA,,4.97,2.98,4.08,4.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoclopramide 5 mg/mL Sol,76765,CDM,,,0636,RC,00409-5255-15,NDC,facility,inpatient,2,ML,,4.97,2.98,4.08,4.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
rifAMPin 300 mg Cap,76800,CDM,,,0637,RC,60687-0586-01,NDC,facility,inpatient,1,EA,,4.97,2.98,4.08,4.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
rifAMPin 300 mg Cap,76800,CDM,,,0637,RC,68084-0358-01,NDC,facility,inpatient,1,EA,,4.97,2.98,4.08,4.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CATHETER FOLEY 20FR 30CC SILICONE,2063901,CDM,A4338,CPT,0272,RC,,,facility,inpatient,,,,4.98,2.99,4.08,4.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-oxyCODONE 325 mg-5 mg Tab [MDH],71508,CDM,,,0636,RC,00406-0512-62,NDC,facility,inpatient,1,EA,,4.98,2.99,4.08,4.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-oxyCODONE 325 mg-5 mg Tab [MDH],71508,CDM,,,0636,RC,50268-0644-15,NDC,facility,inpatient,1,EA,,4.98,2.99,4.08,4.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
megestrol 40 mg Tab [MDH],74991,CDM,,,0637,RC,00904-3571-61,NDC,facility,inpatient,1,EA,,4.98,2.99,4.08,4.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
quiNIDine 324 mg ER Tab [MDH],76757,CDM,,,0637,RC,51079-0027-20,NDC,facility,inpatient,1,EA,,4.98,2.99,4.08,4.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.48,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
SUTURE R-495-T   1 MERSILENE,3141402,CDM,,,0272,RC,,,facility,inpatient,,,,4.99,2.99,4.09,4.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PERMA HAND SILK 6-0 P-3 18 BLACK,3160101,CDM,,,0270,RC,,,facility,inpatient,,,,4.99,2.99,4.09,4.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrogen peroxide Top 3% Sol [MDH],73835,CDM,,,0637,RC,00869-4704-10,NDC,facility,inpatient,240,ML,,4.99,2.99,4.09,4.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PROLENE 6-0 P-3 18 BLUE,3170606,CDM,,,0272,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
INSUFFLATION TUBING ADAPTER,3182806,CDM,,,0272,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
VICRYL 5-0 PS-2 18 UNDYED,3500204,CDM,,,0270,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - COMCAST PER PATIENT,4036,CDM,,,0770,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - DAY HEALTH PER 1/2 HOUR,62050,CDM,,,0930,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - GUEST MEAL GENERAL DIET,66005,CDM,,,0991,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - CORRECT OFFICE MEAL,66006,CDM,,,0991,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 300 mg Cap,70208,CDM,,,0637,RC,60687-0591-01,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 300 mg Cap [MDH],70208,CDM,,,0637,RC,68084-0762-01,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
timolol 5 mg Tab [MDH],71304,CDM,,,0637,RC,00378-0055-01,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bumetanide 1 mg Tab [MDH],71379,CDM,,,0250,RC,00093-4233-01,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylPREDNISolone 4 mg Tab [MDH],74955,CDM,,,0636,RC,00603-4593-15,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylPREDNISolone 4 mg Tab,74955,CDM,,,0636,RC,00603-4593-21,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylPREDNISolone 4 mg Tab [MDH],74955,CDM,,,0636,RC,68001-0005-01,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
morphine 15 mg ER Tab [MDH],75112,CDM,,,0637,RC,00904-6557-61,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 500 mg Tab,75247,CDM,,,0637,RC,68462-0358-01,NDC,facility,inpatient,1,EA,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
CLIENT - SHREDDING FEES,97125,CDM,,,0900,RC,,,facility,inpatient,,,,5,3,4.1,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.1,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-oxyCODONE 325 mg-5 mg Tab [MDH],71508,CDM,,,0636,RC,60687-0642-01,NDC,facility,inpatient,1,EA,,5.02,3.01,4.12,5.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen-oxyCODONE 325 mg-5 mg Tab [MDH],71508,CDM,,,0636,RC,68084-0355-01,NDC,facility,inpatient,1,EA,,5.02,3.01,4.12,5.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.52,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium sulfate 50% Inj Sol 2 mL [MDH],78701,CDM,,,0636,RC,00517-2602-25,NDC,facility,inpatient,2,ML,,5.03,3.02,4.12,5.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
haloperidol 5 mg/mL Inj Sol 1 mL [MDH],73680,CDM,,,0636,RC,67457-0426-12,NDC,facility,inpatient,1,ML,,5.04,3.02,4.13,5.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium sulfate 50% Sol,78701,CDM,,,0636,RC,63323-0064-23,NDC,facility,inpatient,2,ML,,5.04,3.02,4.13,5.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium sulfate 50% Sol,78701,CDM,,,0636,RC,63323-0064-43,NDC,facility,inpatient,2,ML,,5.04,3.02,4.13,5.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.28,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sildenafil 20 mg Tab,71847,CDM,,,0637,RC,00904-6671-04,NDC,facility,inpatient,1,EA,,5.05,3.03,4.14,5.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sildenafil 20 mg Tab,71847,CDM,,,0637,RC,60687-0788-21,NDC,facility,inpatient,1,EA,,5.05,3.03,4.14,5.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.29,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sulfamethoxazole-trimethoprim 800 mg-160 mg Tab [MDH],78046,CDM,,,0637,RC,53746-0272-01,NDC,facility,inpatient,1,EA,,5.07,3.04,4.16,5.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 125 mg sprinkles Cap UD [MDH],72027,CDM,,,0637,RC,68084-0313-01,NDC,facility,inpatient,1,EA,,5.1,3.06,4.18,5.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 500 mg Tab,75247,CDM,,,0637,RC,60687-0374-01,NDC,facility,inpatient,1,EA,,5.1,3.06,4.18,5.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
Benefiber (Wheat Dextrin) 4 gm/1 packet(s) [MDH],72000,CDM,,,0637,RC,86790-0162-80,NDC,facility,inpatient,1,EA,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nystatin 500000 units Tab [MDH],75290,CDM,,,0637,RC,00093-0983-01,NDC,facility,inpatient,1,EA,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
valproic acid 250 mg/5 mL Syr,75594,CDM,,,0637,RC,00121-4675-00,NDC,facility,inpatient,5,ML,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dipyridamole 25 mg Tab,76200,CDM,,,0637,RC,00115-1070-01,NDC,facility,inpatient,1,EA,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dipyridamole 25 mg Tab,76200,CDM,,,0637,RC,64980-0133-01,NDC,facility,inpatient,1,EA,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diclofenac sodium 25 mg Oral EC Tab [MDH],79917,CDM,,,0637,RC,00781-1785-01,NDC,facility,inpatient,1,EA,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diclofenac sodium 25 mg Oral EC Tab [MDH],79917,CDM,,,0637,RC,68001-0202-00,NDC,facility,inpatient,1,EA,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diclofenac sodium 25 mg Tab,79917,CDM,,,0637,RC,68001-0279-00,NDC,facility,inpatient,1,EA,,5.11,3.07,4.19,5.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OXcarbazepine 150 mg Tab,72150,CDM,,,0637,RC,68462-0137-01,NDC,facility,inpatient,1,EA,,5.13,3.08,4.21,5.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clotrimazole 10 mg Loz [MDH],75238,CDM,,,0637,RC,00574-0107-77,NDC,facility,inpatient,1,EA,,5.13,3.08,4.21,5.13,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.13,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 25 mg ER Tab [MDH],70059,CDM,,,0637,RC,00186-1088-39,NDC,facility,inpatient,1,EA,,5.14,3.08,4.21,5.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 50 mg ER Tab [MDH],70164,CDM,,,0637,RC,00186-1090-05,NDC,facility,inpatient,1,EA,,5.14,3.08,4.21,5.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.21,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.37,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
azaTHIOprine 50 mg Tab [MDH],73940,CDM,,,0637,RC,00054-8084-25,NDC,facility,inpatient,1,EA,,5.16,3.1,4.23,5.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 500 mg ER Tab [MDH],71385,CDM,,,0637,RC,68084-0072-01,NDC,facility,inpatient,1,EA,,5.17,3.1,4.24,5.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.65,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxazepam 15 mg Cap [MDH],76995,CDM,,,0637,RC,00228-2069-10,NDC,facility,inpatient,1,EA,,5.19,3.11,4.26,5.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.93,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 120 mg Sup [MDH],78303,CDM,,,0637,RC,45802-0732-30,NDC,facility,inpatient,1,EA,,5.2,3.12,4.26,5.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Supp [MDH],70109,CDM,,,0636,RC,51672-2116-04,NDC,facility,inpatient,1,EA,,5.21,3.13,4.27,5.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.69,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.69,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 850 mg Tab [MDH],70260,CDM,,,0637,RC,00904-6327-61,NDC,facility,inpatient,1,EA,,5.22,3.13,4.28,5.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 25 mg Cap [MDH],75981,CDM,,,0637,RC,00093-0811-01,NDC,facility,inpatient,1,EA,,5.22,3.13,4.28,5.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 25 mg Cap,75981,CDM,,,0637,RC,51672-4002-01,NDC,facility,inpatient,1,EA,,5.22,3.13,4.28,5.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nortriptyline 25 mg Cap,75981,CDM,,,0637,RC,75907-0070-01,NDC,facility,inpatient,1,EA,,5.22,3.13,4.28,5.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydroxyurea 500 mg Cap [MDH],73819,CDM,,,0637,RC,00555-0882-02,NDC,facility,inpatient,1,EA,,5.24,3.14,4.3,5.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 5 mg/mL Inj Sol 2mL [MDH],71787,CDM,,,0636,RC,00641-6063-10,NDC,facility,inpatient,2,ML,,5.25,3.15,4.3,5.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 5 mg/mL Inj Sol 2mL [MDH],71787,CDM,,,0636,RC,00641-6063-25,NDC,facility,inpatient,2,ML,,5.25,3.15,4.3,5.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 10 mEq Tab [MDH],71474,CDM,,,0250,RC,68084-0632-01,NDC,facility,inpatient,1,EA,,5.26,3.16,4.31,5.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
azithromycin 250 mg Tab,75151,CDM,,,0637,RC,50268-0074-15,NDC,facility,inpatient,1,EA,,5.26,3.16,4.31,5.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 650 mg Sup [MDH],70110,CDM,,,0250,RC,45802-0730-32,NDC,facility,inpatient,1,EA,,5.27,3.16,4.32,5.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OXcarbazepine 150 mg Tab UD [MDH],72150,CDM,,,0637,RC,68084-0845-01,NDC,facility,inpatient,1,EA,,5.27,3.16,4.32,5.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tiZANidine 4 mg Tab [MDH],70367,CDM,,,0637,RC,68084-0013-01,NDC,facility,inpatient,1,EA,,5.28,3.17,4.33,5.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tiZANidine 4 mg Tab [MDH],70367,CDM,,,0637,RC,68084-0645-01,NDC,facility,inpatient,1,EA,,5.28,3.17,4.33,5.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midodrine 2.5 mg Tab [MDH],72249,CDM,,,0636,RC,82293-0003-10,NDC,facility,inpatient,1,EA,,5.3,3.18,4.35,5.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pentoxifylline 400 mg ER Tab [MDH],78131,CDM,,,0637,RC,00904-5448-61,NDC,facility,inpatient,1,EA,,5.3,3.18,4.35,5.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pentoxifylline 400 mg ER Tab [MDH],78131,CDM,,,0637,RC,51079-0889-20,NDC,facility,inpatient,1,EA,,5.3,3.18,4.35,5.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.03,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gentamicin 40 mg/mL Sol,73510,CDM,,,0636,RC,00409-1207-25,NDC,facility,inpatient,2,ML,,5.31,3.19,4.35,5.31,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.31,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acyclovir 200 mg Cap,78713,CDM,,,0250,RC,00904-5789-61,NDC,facility,inpatient,1,EA,,5.32,3.19,4.36,5.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.05,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 750 mg Tab [MDH],70430,CDM,,,0637,RC,00185-0146-01,NDC,facility,inpatient,1,EA,,5.33,3.2,4.37,5.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 750 mg Tab [MDH],70430,CDM,,,0637,RC,00591-3671-01,NDC,facility,inpatient,1,EA,,5.33,3.2,4.37,5.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 120 mg Sup,78303,CDM,,,0637,RC,00713-0118-50,NDC,facility,inpatient,1,EA,,5.33,3.2,4.37,5.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin pediatric 1 g Sup,73640,CDM,,,0637,RC,58980-0409-25,NDC,facility,inpatient,1,EA,,5.35,3.21,4.39,5.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 120 mg Supp [MDH],78303,CDM,,,0637,RC,00713-0118-12,NDC,facility,inpatient,1,EA,,5.35,3.21,4.39,5.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.08,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.39,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bisoprolol-hydrochlorothiazide 5 mg-6.25 mg Tab [MDH],71604,CDM,,,0637,RC,54868-4173-00,NDC,facility,inpatient,1,EA,,5.39,3.23,4.42,5.39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.39,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.42,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium bicarbonate 25 mEq Tab,74430,CDM,,,0636,RC,00245-5326-30,NDC,facility,inpatient,1,EA,,5.42,3.25,4.44,5.42,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.42,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.15,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 2 mg/mL Inj Sol 1 mL [MDH],70813,CDM,,,0636,RC,00641-6207-25,NDC,facility,inpatient,1,ML,,5.43,3.26,4.45,5.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nabumetone 750 mg Tab,70430,CDM,,,0637,RC,69097-0966-07,NDC,facility,inpatient,1,EA,,5.44,3.26,4.46,5.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.17,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlordiazePOXIDE-clidinium 5 mg-2.5 mg Cap [MDH],74580,CDM,,,0637,RC,42192-0336-01,NDC,facility,inpatient,1,EA,,5.45,3.27,4.47,5.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 50 mg-200 mg ER Tab [MDH],75132,CDM,,,0637,RC,68084-0282-01,NDC,facility,inpatient,1,EA,,5.45,3.27,4.47,5.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.47,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prednisoLONE sodium phosphate 15 mg/5 mL Oral Liq [MDH],70309,CDM,,,0636,RC,00121-0759-08,NDC,facility,inpatient,237,ML,,5.46,3.28,4.48,5.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 2.5 mg Tab,71429,CDM,,,0637,RC,00904-6369-61,NDC,facility,inpatient,1,EA,,5.47,3.28,4.49,5.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 400 mg Cap,71552,CDM,,,0637,RC,65162-0103-10,NDC,facility,inpatient,1,EA,,5.48,3.29,4.49,5.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fludrocortisone 0.1 mg Tab,73363,CDM,,,0637,RC,50268-0330-15,NDC,facility,inpatient,1,EA,,5.48,3.29,4.49,5.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.66,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gabapentin 400 mg Cap [MDH],71552,CDM,,,0637,RC,68084-0595-01,NDC,facility,inpatient,1,EA,,5.49,3.29,4.5,5.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carBAMazepine 200 mg Tab [MDH],77685,CDM,,,0637,RC,51079-0385-20,NDC,facility,inpatient,1,EA,,5.49,3.29,4.5,5.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 50 mg Chew Tab [MDH],72655,CDM,,,0637,RC,00071-0007-24,NDC,facility,inpatient,1,EA,,5.5,3.3,4.51,5.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
terazosin 1 mg Cap [MDH],73881,CDM,,,0637,RC,00378-2260-01,NDC,facility,inpatient,1,EA,,5.5,3.3,4.51,5.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
terazosin 1 mg Cap [MDH],73881,CDM,,,0637,RC,51079-0936-20,NDC,facility,inpatient,1,EA,,5.5,3.3,4.51,5.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
terazosin 1 mg Cap,73881,CDM,,,0637,RC,59746-0383-06,NDC,facility,inpatient,1,EA,,5.5,3.3,4.51,5.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
terazosin 5 mg Cap [MDH],75129,CDM,,,0637,RC,00378-2268-01,NDC,facility,inpatient,1,EA,,5.5,3.3,4.51,5.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
terazosin 5 mg Cap [MDH],75129,CDM,,,0637,RC,51079-0938-20,NDC,facility,inpatient,1,EA,,5.5,3.3,4.51,5.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
terazosin 5 mg Cap,75129,CDM,,,0637,RC,59746-0385-06,NDC,facility,inpatient,1,EA,,5.5,3.3,4.51,5.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyproheptadine 4 mg Tab,76150,CDM,,,0637,RC,64720-0150-10,NDC,facility,inpatient,1,EA,,5.51,3.31,4.52,5.51,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.51,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pregabalin 50 mg Cap,71372,CDM,,,0637,RC,60687-0484-01,NDC,facility,inpatient,1,EA,,5.53,3.32,4.53,5.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.53,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pregabalin 75 mg Cap,71386,CDM,,,0637,RC,60687-0495-01,NDC,facility,inpatient,1,EA,,5.53,3.32,4.53,5.53,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.53,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
valsartan 40 mg Tab,71423,CDM,,,0637,RC,55111-0731-30,NDC,facility,inpatient,1,EA,,5.54,3.32,4.54,5.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,4.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 125 mcg (0.125 mg) Tab [MDH],70095,CDM,,,0637,RC,00074-7068-11,NDC,facility,inpatient,1,EA,,5.57,3.34,4.57,5.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 75 mcg (0.075 mg) Tab [MDH],70160,CDM,,,0637,RC,00074-5182-11,NDC,facility,inpatient,1,EA,,5.57,3.34,4.57,5.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 88 mcg (0.088 mg) Tab [MDH],70308,CDM,,,0637,RC,00074-6594-90,NDC,facility,inpatient,1,EA,,5.57,3.34,4.57,5.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 50 mcg (0.05 mg) Tab [MDH],77525,CDM,,,0637,RC,00074-4552-11,NDC,facility,inpatient,1,EA,,5.57,3.34,4.57,5.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 100 mcg (0.1 mg) Tab [MDH],77530,CDM,,,0637,RC,00074-6624-11,NDC,facility,inpatient,1,EA,,5.57,3.34,4.57,5.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levothyroxine 150 mcg (0.15 mg) Tab [MDH],77540,CDM,,,0637,RC,00074-7069-11,NDC,facility,inpatient,1,EA,,5.57,3.34,4.57,5.57,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.57,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.01,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 240 mg ER Tab [MDH],71439,CDM,,,0637,RC,00093-3045-01,NDC,facility,inpatient,1,EA,,5.58,3.35,4.58,5.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 240 mg/12 hours Tab,71439,CDM,,,0637,RC,68462-0260-01,NDC,facility,inpatient,1,EA,,5.58,3.35,4.58,5.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 240 mg/12 hours Tab,71439,CDM,,,0637,RC,75834-0159-01,NDC,facility,inpatient,1,EA,,5.58,3.35,4.58,5.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propafenone 150 mg Tab [MDH],72197,CDM,,,0636,RC,00603-5448-21,NDC,facility,inpatient,1,EA,,5.58,3.35,4.58,5.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propafenone 150 mg Tab,72197,CDM,,,0636,RC,62559-0230-01,NDC,facility,inpatient,1,EA,,5.58,3.35,4.58,5.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 5 mg Tab,75234,CDM,,,0637,RC,00904-6370-61,NDC,facility,inpatient,1,EA,,5.59,3.35,4.58,5.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.03,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.03,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Sup,70109,CDM,,,0636,RC,00713-0164-50,NDC,facility,inpatient,1,EA,,5.6,3.36,4.59,5.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nitroglycerin 0.4 mg sublingual Tab [MDH],75680,CDM,,,0637,RC,00071-0418-13,NDC,facility,inpatient,1,EA,,5.6,3.36,4.59,5.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carBAMazepine 200 mg Tab [MDH],77685,CDM,,,0637,RC,68084-0444-01,NDC,facility,inpatient,1,EA,,5.6,3.36,4.59,5.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.59,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Supp [MDH],70109,CDM,,,0636,RC,00713-0164-12,NDC,facility,inpatient,1,EA,,5.62,3.37,4.61,5.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide mononitrate 30 mg ER Tab [MDH],70231,CDM,,,0637,RC,00904-6449-61,NDC,facility,inpatient,1,EA,,5.63,3.38,4.62,5.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.35,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 100 mg/5 mL Liq,70025,CDM,,,0637,RC,00121-1488-00,NDC,facility,inpatient,10,ML,,5.64,3.38,4.62,5.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
guaiFENesin 100 mg/5 mL Oral Liq [MDH],70025,CDM,,,0637,RC,00121-1744-10,NDC,facility,inpatient,10,ML,,5.64,3.38,4.62,5.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
buPROPion 100 mg ER Tab [MDH],71813,CDM,,,0637,RC,68084-0697-01,NDC,facility,inpatient,1,EA,,5.64,3.38,4.62,5.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 60 mg ERCap [MDH],79907,CDM,,,0637,RC,68084-0209-01,NDC,facility,inpatient,1,EA,,5.65,3.39,4.63,5.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 650 mg Sup,70110,CDM,,,0637,RC,45802-0730-30,NDC,facility,inpatient,1,EA,,5.66,3.4,4.64,5.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
losartan 25 mg Tab [MDH],72253,CDM,,,0637,RC,31722-0700-90,NDC,facility,inpatient,1,EA,,5.66,3.4,4.64,5.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide mononitrate 30 mg ER Tab [MDH],70231,CDM,,,0637,RC,68084-0591-01,NDC,facility,inpatient,1,EA,,5.67,3.4,4.65,5.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 100 mg Tab,70287,CDM,,,0637,RC,50268-0542-15,NDC,facility,inpatient,1,EA,,5.67,3.4,4.65,5.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 100 mg ER Tab [MDH],70287,CDM,,,0637,RC,68084-0301-01,NDC,facility,inpatient,1,EA,,5.67,3.4,4.65,5.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol succinate 100 mg ER Tab [MDH],70287,CDM,,,0637,RC,68084-0673-01,NDC,facility,inpatient,1,EA,,5.67,3.4,4.65,5.67,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.67,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 1 mg/mL Sol,74693,CDM,,,0636,RC,36000-0033-10,NDC,facility,inpatient,5,ML,,5.69,3.41,4.67,5.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
APAP/butalbital/caffeine 325 mg-50 mg-40 mg Tab [MDH],73351,CDM,,,0637,RC,00591-3369-01,NDC,facility,inpatient,1,EA,,5.7,3.42,4.67,5.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
buPROPion 100 mg ER Tab [MDH],71813,CDM,,,0637,RC,68084-0470-01,NDC,facility,inpatient,1,EA,,5.71,3.43,4.68,5.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pravastatin 10mg tab (1/2) [MDH],71882,CDM,,,0250,RC,68084-0501-11A,NDC,facility,inpatient,1,EA,,5.71,3.43,4.68,5.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
neomycin 500 mg Tab [MDH],75515,CDM,,,0637,RC,39822-0310-05,NDC,facility,inpatient,1,EA,,5.72,3.43,4.69,5.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.69,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levETIRAcetam 100 mg/mL Sol,71972,CDM,,,0637,RC,00121-0799-16,NDC,facility,inpatient,473,ML,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levETIRAcetam 100 mg/mL Sol [MDH],71972,CDM,,,0637,RC,31722-0574-47,NDC,facility,inpatient,473,ML,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ASA/butalbital/caffeine Cap [MDH],73345,CDM,,,0637,RC,00527-1552-01,NDC,facility,inpatient,1,EA,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ASA/butalbital/caffeine Cap [MDH],73345,CDM,,,0637,RC,00591-3219-01,NDC,facility,inpatient,1,EA,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
minocycline 50 mg Cap [MDH],75150,CDM,,,0637,RC,00591-5694-01,NDC,facility,inpatient,1,EA,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
minocycline 50 mg Cap,75150,CDM,,,0637,RC,00591-5694-60,NDC,facility,inpatient,1,EA,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
minocycline 50 mg Cap,75150,CDM,,,0637,RC,13668-0482-01,NDC,facility,inpatient,1,EA,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
minocycline 50 mg Cap [MDH],75150,CDM,,,0637,RC,63304-0694-01,NDC,facility,inpatient,1,EA,,5.73,3.44,4.7,5.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.7,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab [MDH],41436,CDM,,,0250,RC,00591-3256-01,NDC,facility,inpatient,1,EA,,5.74,3.44,4.71,5.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab [MDH],41436,CDM,,,0250,RC,00603-3078-21,NDC,facility,inpatient,1,EA,,5.74,3.44,4.71,5.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab,41436,CDM,,,0636,RC,29300-0413-01,NDC,facility,inpatient,1,EA,,5.74,3.44,4.71,5.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab,41436,CDM,,,0250,RC,43547-0399-10,NDC,facility,inpatient,1,EA,,5.74,3.44,4.71,5.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
megestrol 40 mg Tab [MDH],74991,CDM,,,0637,RC,00555-0607-02,NDC,facility,inpatient,1,EA,,5.75,3.45,4.72,5.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OLANZapine 5 mg ODT Tab [MDH],71821,CDM,,,0637,RC,00093-5245-19,NDC,facility,inpatient,1,EA,,5.76,3.46,4.72,5.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylPREDNISolone 4 mg Tab,74955,CDM,,,0636,RC,68382-0916-01,NDC,facility,inpatient,1,EA,,5.77,3.46,4.73,5.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.48,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zonisamide 100 mg Cap,71121,CDM,,,0637,RC,50268-0816-15,NDC,facility,inpatient,1,EA,,5.78,3.47,4.74,5.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.91,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 2.5 mg Tab [MDH],71429,CDM,,,0250,RC,51079-0450-20,NDC,facility,inpatient,1,EA,,5.8,3.48,4.76,5.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 5 mg Tab [MDH],75234,CDM,,,0637,RC,51079-0451-20,NDC,facility,inpatient,1,EA,,5.8,3.48,4.76,5.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab,76118,CDM,,,0637,RC,46122-0168-78,NDC,facility,inpatient,1,EA,,5.8,3.48,4.76,5.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 5 mg Tab,75234,CDM,,,0637,RC,59762-2010-09,NDC,facility,inpatient,1,EA,,5.81,3.49,4.76,5.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab,76118,CDM,,,0636,RC,62332-0001-91,NDC,facility,inpatient,1,EA,,5.81,3.49,4.76,5.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.76,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.94,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab [MDH],76118,CDM,,,0637,RC,51079-0966-20,NDC,facility,inpatient,1,EA,,5.82,3.49,4.77,5.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 50 mg-200 mg ER Tab [MDH],75132,CDM,,,0637,RC,51079-0923-20,NDC,facility,inpatient,1,EA,,5.83,3.5,4.78,5.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab [MDH],76118,CDM,,,0637,RC,64679-0936-02,NDC,facility,inpatient,1,EA,,5.83,3.5,4.78,5.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,4.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 250 mg Oral DR Tab [MDH],72455,CDM,,,0637,RC,00378-1044-01,NDC,facility,inpatient,1,EA,,5.88,3.53,4.82,5.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 250 mg Oral DR Tab [MDH],72455,CDM,,,0637,RC,68084-0776-01,NDC,facility,inpatient,1,EA,,5.88,3.53,4.82,5.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 650 mg Supp [MDH],70110,CDM,,,0637,RC,00713-0165-12,NDC,facility,inpatient,1,EA,,5.89,3.53,4.83,5.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.6,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diclofenac sodium 75 mg Oral EC Tab [MDH],70060,CDM,,,0637,RC,00781-1789-01,NDC,facility,inpatient,1,EA,,5.91,3.55,4.85,5.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diclofenac sodium 75 mg Tab,70060,CDM,,,0637,RC,68001-0281-06,NDC,facility,inpatient,1,EA,,5.91,3.55,4.85,5.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amiodarone 50 mg/mL Sol,70238,CDM,,,0636,RC,63323-0616-03,NDC,facility,inpatient,3,ML,,5.91,3.55,4.85,5.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 2 mg/mL Sol,70813,CDM,,,0636,RC,65219-0368-02,NDC,facility,inpatient,1,ML,,5.92,3.55,4.85,5.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.85,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.33,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 25 mg Tab [MDH],78345,CDM,,,0637,RC,68084-0110-01,NDC,facility,inpatient,1,EA,,5.93,3.56,4.86,5.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
buPROPion 100 mg Tab,78750,CDM,,,0637,RC,60687-0351-01,NDC,facility,inpatient,1,EA,,5.93,3.56,4.86,5.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amLODIPine 5 mg Tab,75234,CDM,,,0637,RC,67877-0198-90,NDC,facility,inpatient,1,EA,,5.94,3.56,4.87,5.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
NIFEdipine 30 mg Tab,78747,CDM,,,0637,RC,68084-0597-01,NDC,facility,inpatient,1,EA,,5.94,3.56,4.87,5.94,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.94,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 1 mg Tab [MDH],70072,CDM,,,0637,RC,00560-0169-01,NDC,facility,inpatient,1,EA,,5.95,3.57,4.88,5.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 50 mg Tab [MDH],72655,CDM,,,0637,RC,60687-0156-25,NDC,facility,inpatient,1,EA,,5.97,3.58,4.9,5.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 50 mg-200 mg Tab,75132,CDM,,,0637,RC,50228-0461-01,NDC,facility,inpatient,1,EA,,5.98,3.59,4.9,5.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
prazosin 1 mg Cap [MDH],75145,CDM,,,0637,RC,51079-0630-20,NDC,facility,inpatient,1,EA,,6,3.6,4.92,6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.1,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 20 mEq Pow,72311,CDM,,,0637,RC,60687-0855-27,NDC,facility,inpatient,1,EA,,6.03,3.62,4.94,6.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 180 mg/24 hours Cap,77034,CDM,,,0637,RC,00591-2882-01,NDC,facility,inpatient,1,EA,,6.04,3.62,4.95,6.04,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.04,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab [MDH],41436,CDM,,,0250,RC,59746-0211-06,NDC,facility,inpatient,1,EA,,6.05,3.63,4.96,6.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROmorphone 2 mg/mL Inj Sol 1 mL [MDH],71660,CDM,,,0636,RC,00641-0121-25,NDC,facility,inpatient,1,ML,,6.05,3.63,4.96,6.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate sodium 100 mg/10 mL Oral Liq 10mL [MDH],75591,CDM,,,0637,RC,00121-0544-10,NDC,facility,inpatient,10,ML,,6.05,3.63,4.96,6.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate 10 mg/mL Liq,75591,CDM,,,0637,RC,00121-1870-00,NDC,facility,inpatient,10,ML,,6.05,3.63,4.96,6.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyclobenzaprine 5 mg Tab [MDH],41436,CDM,,,0250,RC,10702-0006-01,NDC,facility,inpatient,1,EA,,6.07,3.64,4.98,6.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methyclothiazide 5 mg Tab [MDH],73140,CDM,,,0637,RC,00378-0160-01,NDC,facility,inpatient,1,EA,,6.07,3.64,4.98,6.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",4.98,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.16,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
perphenazine 2 mg Tab,78200,CDM,,,0636,RC,00591-4101-01,NDC,facility,inpatient,1,EA,,6.11,3.67,5.01,6.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
perphenazine 2 mg Tab,78200,CDM,,,0636,RC,64980-0290-01,NDC,facility,inpatient,1,EA,,6.11,3.67,5.01,6.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.5,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.01,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.5,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
doxycycline monohydrate 100 mg Cap [MDH],78520,CDM,,,0637,RC,68084-0743-32,NDC,facility,inpatient,1,EA,,6.12,3.67,5.02,6.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.51,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.2,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.51,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
morphine 15 mg ER Tab [MDH],75112,CDM,,,0637,RC,00406-8315-62,NDC,facility,inpatient,1,EA,,6.14,3.68,5.03,6.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.14,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.22,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin pediatric Sup,73640,CDM,,,0637,RC,00713-0102-09,NDC,facility,inpatient,1,EA,,6.15,3.69,5.04,6.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.84,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.23,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
QUEtiapine 12.5 mg tab (1/2) [MDH],71883,CDM,,,0637,RC,68084-0530-11A,NDC,facility,inpatient,1,EA,,6.17,3.7,5.06,6.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
polyethylene glycol 3350 - Pow,72909,CDM,,,0637,RC,51079-0306-30,NDC,facility,inpatient,1,EA,,6.17,3.7,5.06,6.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.55,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tamoxifen 10 mg Tab,75710,CDM,,,0637,RC,00591-2472-60,NDC,facility,inpatient,1,EA,,6.2,3.72,5.08,6.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.58,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.89,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.08,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.27,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.58,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fenofibrate 48 mg Tab,70388,CDM,,,0637,RC,00378-3065-77,NDC,facility,inpatient,1,EA,,6.23,3.74,5.11,6.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fenofibrate 48 mg Tab,70388,CDM,,,0637,RC,51079-0599-20,NDC,facility,inpatient,1,EA,,6.23,3.74,5.11,6.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fenofibrate 48 mg Tab,70388,CDM,,,0637,RC,60687-0618-21,NDC,facility,inpatient,1,EA,,6.23,3.74,5.11,6.23,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.23,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.92,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.11,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.3,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
isosorbide dinitrate 40 mg Tab [MDH],78724,CDM,,,0637,RC,64455-0192-01,NDC,facility,inpatient,1,EA,,6.25,3.75,5.12,6.25,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.25,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.94,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.31,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxytocin 10 intl units/mL Inj Sol 1 mL [MDH],76365,CDM,,,0636,RC,63323-0012-01,NDC,facility,inpatient,1,ML,,6.26,3.76,5.13,6.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxytocin 10 intl units/mL Inj Sol 1 mL [MDH],76365,CDM,,,0636,RC,63323-0012-12,NDC,facility,inpatient,1,ML,,6.26,3.76,5.13,6.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.95,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cilostazol 50 mg Tab [MDH],73000,CDM,,,0636,RC,00093-2065-06,NDC,facility,inpatient,1,EA,,6.27,3.76,5.14,6.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.96,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.14,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.33,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.64,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
buPROPion 150 mg SR/12hr Tab [MDH],70360,CDM,,,0250,RC,00591-3541-60,NDC,facility,inpatient,1,EA,,6.29,3.77,5.16,6.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
glycerin adult Supp [MDH],73645,CDM,,,0637,RC,00713-0101-09,NDC,facility,inpatient,1,EA,,6.29,3.77,5.16,6.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.66,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.66,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
valsartan 80 mg Tab,71136,CDM,,,0637,RC,55111-0732-90,NDC,facility,inpatient,1,EA,,6.3,3.78,5.17,6.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
promethazine 25 mg/mL Inj Sol 1 mL [MDH],76245,CDM,,,0636,RC,00641-1495-31,NDC,facility,inpatient,1,ML,,6.3,3.78,5.17,6.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxytocin 10 intl units/mL Inj Sol 1 mL [MDH],76365,CDM,,,0636,RC,63323-0012-07,NDC,facility,inpatient,1,ML,,6.3,3.78,5.17,6.3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.3,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 6.25 mg Tab [MDH],70211,CDM,,,0637,RC,68084-0854-01,NDC,facility,inpatient,1,EA,,6.33,3.8,5.19,6.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 12.5 mg Tab [MDH],71402,CDM,,,0637,RC,68084-0865-01,NDC,facility,inpatient,1,EA,,6.33,3.8,5.19,6.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 25 mg Tab [MDH],71403,CDM,,,0637,RC,68084-0264-01,NDC,facility,inpatient,1,EA,,6.33,3.8,5.19,6.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 25 mg Tab [MDH],71403,CDM,,,0637,RC,68084-0876-01,NDC,facility,inpatient,1,EA,,6.33,3.8,5.19,6.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cefTRIAXone 1 g Pow,74013,CDM,,,0636,RC,00409-7332-20,NDC,facility,inpatient,1,EA,,6.33,3.8,5.19,6.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 3.125 mg Tab [MDH],81687,CDM,,,0637,RC,68084-0843-01,NDC,facility,inpatient,1,EA,,6.33,3.8,5.19,6.33,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.33,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.19,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
buPROPion 100 mg Tab [MDH],78750,CDM,,,0637,RC,51079-0944-20,NDC,facility,inpatient,1,EA,,6.36,3.82,5.22,6.36,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.36,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ergocalciferol 50000 intl units Cap [MDH],72890,CDM,,,0637,RC,51991-0604-01,NDC,facility,inpatient,1,EA,,6.38,3.83,5.23,6.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ergocalciferol 50000 intl units Cap,72890,CDM,,,0637,RC,64380-0737-06,NDC,facility,inpatient,1,EA,,6.38,3.83,5.23,6.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
codeine-guaifenesin 10 mg-100 mg/5 mL Syr [MDH],79030,CDM,,,0637,RC,00121-1550-00,NDC,facility,inpatient,10,ML,,6.38,3.83,5.23,6.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
codeine-guaiFENesin 10 mg-100 mg/5 mL Oral Syrup 10 mL [MDH],79030,CDM,,,0637,RC,00121-1775-10,NDC,facility,inpatient,10,ML,,6.38,3.83,5.23,6.38,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.38,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.74,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zonisamide 100 mg Cap [MDH],71121,CDM,,,0637,RC,51079-0768-20,NDC,facility,inpatient,1,EA,,6.39,3.83,5.24,6.39,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.39,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.07,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg Sup,70109,CDM,,,0636,RC,51672-2116-02,NDC,facility,inpatient,1,EA,,6.41,3.85,5.26,6.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 500 mg/100 mL IV Sol [MDH],73357,CDM,,,0636,RC,00409-7811-37,NDC,facility,inpatient,100,ML,,6.44,3.86,5.28,6.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 10 mg Tab [MDH],78340,CDM,,,0637,RC,00832-0511-89,NDC,facility,inpatient,1,EA,,6.45,3.87,5.29,6.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
venlafaxine 37.5 mg Tab [MDH],79007,CDM,,,0637,RC,00093-7380-01,NDC,facility,inpatient,1,EA,,6.45,3.87,5.29,6.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
venlafaxine 37.5 mg Tab,79007,CDM,,,0637,RC,57664-0393-88,NDC,facility,inpatient,1,EA,,6.45,3.87,5.29,6.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
venlafaxine 37.5 mg Tab [MDH],79007,CDM,,,0637,RC,68084-0844-01,NDC,facility,inpatient,1,EA,,6.45,3.87,5.29,6.45,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.13,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 10 mg Tab,78340,CDM,,,0637,RC,00832-0511-01,NDC,facility,inpatient,1,EA,,6.46,3.88,5.3,6.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levoFLOXacin 250 mg/50 mL IV Sol [MDH],70246,CDM,,,0636,RC,00143-9315-24,NDC,facility,inpatient,50,ML,,6.48,3.89,5.31,6.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metFORMIN 850 mg Tab [MDH],70260,CDM,,,0637,RC,00087-6070-05,NDC,facility,inpatient,1,EA,,6.48,3.89,5.31,6.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 15 mg Tab [MDH],71810,CDM,,,0637,RC,51079-0960-20,NDC,facility,inpatient,1,EA,,6.5,3.9,5.33,6.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 15 mg Tab,71810,CDM,,,0637,RC,68382-0182-01,NDC,facility,inpatient,1,EA,,6.5,3.9,5.33,6.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
flecainide 50 mg Tab [MDH],72307,CDM,,,0637,RC,00054-0010-21,NDC,facility,inpatient,1,EA,,6.5,3.9,5.33,6.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amantadine 100 mg Cap,77435,CDM,,,0637,RC,00832-1015-00,NDC,facility,inpatient,1,EA,,6.5,3.9,5.33,6.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amantadine 100 mg Cap [MDH],77435,CDM,,,0637,RC,00832-2012-00,NDC,facility,inpatient,1,EA,,6.5,3.9,5.33,6.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amantadine 100 mg Cap *,77435,CDM,,,0637,RC,16571-0834-01,NDC,facility,inpatient,1,EA,,6.5,3.9,5.33,6.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.33,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.52,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 180 mg ERCap [MDH],77034,CDM,,,0637,RC,00378-6380-01,NDC,facility,inpatient,1,EA,,6.52,3.91,5.35,6.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.19,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.35,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ticlopidine 250 mg Tab [MDH],75228,CDM,,,0637,RC,00093-0154-01,NDC,facility,inpatient,1,EA,,6.54,3.92,5.36,6.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 60 mg Cap,79907,CDM,,,0637,RC,43478-0900-88,NDC,facility,inpatient,1,EA,,6.55,3.93,5.37,6.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 60 mg Cap,79907,CDM,,,0637,RC,62559-0530-01,NDC,facility,inpatient,1,EA,,6.55,3.93,5.37,6.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 10 mg/mL Inj Sol 2mL [MDH],74540,CDM,,,0636,RC,00517-5702-25,NDC,facility,inpatient,2,ML,,6.56,3.94,5.38,6.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.58,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.9,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROmorphone 2 mg/mL Inj Sol 1 mL [MDH],71660,CDM,,,0636,RC,00409-3365-01,NDC,facility,inpatient,1,ML,,6.59,3.95,5.4,6.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
potassium chloride 2 mEq/mL IV Sol 20 mL [MDH],76460,CDM,,,0636,RC,63323-0965-20,NDC,facility,inpatient,20,ML,,6.59,3.95,5.4,6.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 60 mg Cap,79907,CDM,,,0637,RC,00527-4116-37,NDC,facility,inpatient,1,EA,,6.59,3.95,5.4,6.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
anastrozole 1 mg Tab UD [MDH],71715,CDM,,,0637,RC,68084-0448-21,NDC,facility,inpatient,1,EA,,6.62,3.97,5.43,6.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.43,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OLANZapine 5 mg Tab,71821,CDM,,,0637,RC,55111-0262-81,NDC,facility,inpatient,1,EA,,6.63,3.98,5.44,6.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metolazone 2.5 mg Tab [MDH],72770,CDM,,,0637,RC,00185-5050-01,NDC,facility,inpatient,1,EA,,6.63,3.98,5.44,6.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab [MDH],76118,CDM,,,0637,RC,61442-0121-01,NDC,facility,inpatient,1,EA,,6.63,3.98,5.44,6.63,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.63,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.97,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.97,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 30 mg/mL Sol,70224,CDM,,,0636,RC,00641-6042-25,NDC,facility,inpatient,1,ML,,6.64,3.98,5.44,6.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium sulfate 50% Inj Sol 2 mL [MDH],78701,CDM,,,0636,RC,63323-0064-09,NDC,facility,inpatient,2,ML,,6.64,3.98,5.44,6.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.64,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 12.5 mg Tab,71402,CDM,,,0637,RC,00904-6302-61,NDC,facility,inpatient,1,EA,,6.69,4.01,5.49,6.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 12.5 mg Tab [MDH],71402,CDM,,,0637,RC,68462-0164-01,NDC,facility,inpatient,1,EA,,6.69,4.01,5.49,6.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 25 mg Tab,71403,CDM,,,0637,RC,00904-6303-61,NDC,facility,inpatient,1,EA,,6.69,4.01,5.49,6.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
topiramate 25 mg Tab [MDH],78016,CDM,,,0250,RC,68084-0342-01,NDC,facility,inpatient,1,EA,,6.69,4.01,5.49,6.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 3.125 mg Tab,81687,CDM,,,0637,RC,00904-6300-61,NDC,facility,inpatient,1,EA,,6.69,4.01,5.49,6.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.69,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
azaTHIOprine 50 mg Tab,73940,CDM,,,0637,RC,68382-0003-01,NDC,facility,inpatient,1,EA,,6.71,4.03,5.5,6.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.04,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.04,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diphenhydrAMINE 50 mg/mL Sol,71070,CDM,,,0636,RC,72485-0101-25,NDC,facility,inpatient,1,ML,,6.72,4.03,5.51,6.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cefTRIAXone 1 gram Powder for Inj [MDH],74013,CDM,,,0636,RC,00409-7332-01,NDC,facility,inpatient,1,EA,,6.72,4.03,5.51,6.72,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.72,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.05,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.05,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
busPIRone 15 mg Tab,71810,CDM,,,0637,RC,64380-0743-03,NDC,facility,inpatient,1,EA,,6.73,4.04,5.52,6.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
HYDROmorphone 2 mg/mL Sol,71660,CDM,,,0636,RC,00409-3365-10,NDC,facility,inpatient,1,ML,,6.74,4.04,5.53,6.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.4,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pancrelipase 6000 units-19000 units-30000 units Cap[MDH],72054,CDM,,,0636,RC,00032-1206-01,NDC,facility,inpatient,1,EA,,6.76,4.06,5.54,6.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carbidopa-levodopa 50 mg-200 mg ER Tab [MDH],75132,CDM,,,0637,RC,51079-0923-19,NDC,facility,inpatient,1,EA,,6.76,4.06,5.54,6.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.08,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.42,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.08,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 12.5 mg Tab [MDH],71402,CDM,,,0637,RC,51079-0931-20,NDC,facility,inpatient,1,EA,,6.77,4.06,5.55,6.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 25 mg Tab [MDH],71403,CDM,,,0637,RC,51079-0932-20,NDC,facility,inpatient,1,EA,,6.77,4.06,5.55,6.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 25 mg Tab,71403,CDM,,,0637,RC,68001-0152-00,NDC,facility,inpatient,1,EA,,6.77,4.06,5.55,6.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 3.125 mg Tab [MDH],81687,CDM,,,0637,RC,51079-0771-20,NDC,facility,inpatient,1,EA,,6.77,4.06,5.55,6.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
carvedilol 3.125 mg Tab,81687,CDM,,,0637,RC,68001-0153-00,NDC,facility,inpatient,1,EA,,6.78,4.07,5.56,6.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.44,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.56,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.76,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fentaNYL 0.05 mg/mL Inj Sol 5mL [MDH],71521,CDM,,,0636,RC,00409-9094-25,NDC,facility,inpatient,5,ML,,6.79,4.07,5.57,6.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
valproic acid 250 mg/5 mL Syr UD 5 mL [MDH],75594,CDM,,,0637,RC,00121-4675-05,NDC,facility,inpatient,5,ML,,6.79,4.07,5.57,6.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 25 mg Tab [MDH],78345,CDM,,,0637,RC,00527-1356-01,NDC,facility,inpatient,1,EA,,6.79,4.07,5.57,6.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 25 mg Tab,78345,CDM,,,0637,RC,65162-0573-10,NDC,facility,inpatient,1,EA,,6.79,4.07,5.57,6.79,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.79,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.77,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
codeine-guaifenesin 10 mg-100 mg/5 mL Syr,79030,CDM,,,0637,RC,50383-0087-12,NDC,facility,inpatient,10,ML,,6.8,4.08,5.58,6.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-spironolactone 25 mg-25 mg Tab [MDH],70265,CDM,,,0637,RC,51079-0104-20,NDC,facility,inpatient,1,EA,,6.83,4.1,5.6,6.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
hydrochlorothiazide-methyldopa 25 mg-250 mg Tab [MDH],70310,CDM,,,0637,RC,00378-0711-01,NDC,facility,inpatient,1,EA,,6.83,4.1,5.6,6.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 10 mg Tab,75214,CDM,,,0637,RC,00093-0314-01,NDC,facility,inpatient,1,EA,,6.83,4.1,5.6,6.83,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.83,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.15,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
venlafaxine 37.5 mg Cap,70366,CDM,,,0637,RC,50268-0873-15,NDC,facility,inpatient,1,EA,,6.86,4.12,5.63,6.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
perphenazine 2 mg Tab [MDH],78200,CDM,,,0636,RC,00781-1046-13,NDC,facility,inpatient,1,EA,,6.88,4.13,5.64,6.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.54,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
orphenadrine 100 mg ER Tab [MDH],75720,CDM,,,0636,RC,00185-0022-01,NDC,facility,inpatient,1,EA,,6.89,4.13,5.65,6.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.2,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.65,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.2,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 100 mg/5 mL Sus UD 5 mL [MDH],71648,CDM,,,0637,RC,66689-0009-01,NDC,facility,inpatient,5,ML,,6.96,4.18,5.71,6.96,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.96,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tacrolimus 0.5 mg Cap [MDH],72186,CDM,,,0636,RC,16729-0041-01,NDC,facility,inpatient,1,EA,,7,4.2,5.74,7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tacrolimus 0.5 mg Cap,72186,CDM,,,0636,RC,55111-0525-01,NDC,facility,inpatient,1,EA,,7,4.2,5.74,7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.3,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 60 mg ERCap [MDH],79907,CDM,,,0637,RC,68084-0503-01,NDC,facility,inpatient,1,EA,,7.01,4.21,5.75,7.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.31,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.75,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.31,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
losartan 50 mg Tab [MDH],79022,CDM,,,0637,RC,31722-0701-90,NDC,facility,inpatient,1,EA,,7.05,4.23,5.78,7.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
losartan 50 mg Tab [MDH],79022,CDM,,,0637,RC,68084-0347-01,NDC,facility,inpatient,1,EA,,7.05,4.23,5.78,7.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,5.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
salsalate 750 mg Tab,72761,CDM,,,0637,RC,51293-0616-01,NDC,facility,inpatient,1,EA,,7.07,4.24,5.8,7.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
losartan 50 mg Tab [MDH],79022,CDM,,,0637,RC,13668-0409-90,NDC,facility,inpatient,1,EA,,7.07,4.24,5.8,7.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.01,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
silver nitrate Top Stick [MDH],77047,CDM,,,0250,RC,12870-0001-02,NDC,facility,inpatient,1,EA,,7.08,4.25,5.81,7.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
losartan 50 mg Tab,79022,CDM,,,0636,RC,65862-0202-30,NDC,facility,inpatient,1,EA,,7.08,4.25,5.81,7.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
losartan 50 mg Tab,79022,CDM,,,0636,RC,65862-0202-90,NDC,facility,inpatient,1,EA,,7.08,4.25,5.81,7.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.73,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 10 mg Tab [MDH],75214,CDM,,,0637,RC,00378-1134-01,NDC,facility,inpatient,1,EA,,7.09,4.25,5.81,7.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dronabinol 2.5 mg Cap,81800,CDM,,,0636,RC,42858-0867-06,NDC,facility,inpatient,1,EA,,7.09,4.25,5.81,7.09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.09,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.38,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 50 mg Chew Tab [MDH],72655,CDM,,,0637,RC,00071-0007-40,NDC,facility,inpatient,1,EA,,7.11,4.27,5.83,7.11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.11,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.83,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
naproxen sodium 275 mg Tab [MDH],70523,CDM,,,0637,RC,68462-0178-01,NDC,facility,inpatient,1,EA,,7.15,4.29,5.86,7.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.79,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.86,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.08,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 2 mg/mL Sol,70813,CDM,,,0636,RC,00409-6778-02,NDC,facility,inpatient,1,ML,,7.16,4.3,5.87,7.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlorthalidone 25 mg Tab [MDH],73851,CDM,,,0637,RC,51079-0058-20,NDC,facility,inpatient,1,EA,,7.16,4.3,5.87,7.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.87,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 100 mg/5 mL Sus,71648,CDM,,,0637,RC,68094-0494-61,NDC,facility,inpatient,5,ML,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 100 mg/5 mL Sus,71648,CDM,,,0636,RC,68094-0494-62,NDC,facility,inpatient,5,ML,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fluvoxaMINE 25 mg Tab [MDH],71844,CDM,,,0637,RC,62559-0158-01,NDC,facility,inpatient,1,EA,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
digoxin 125 mcg (0.125 mg) Tab,74473,CDM,,,0637,RC,00143-1240-01,NDC,facility,inpatient,1,EA,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
digoxin 125 mcg (0.125 mg) Tab [MDH],74473,CDM,,,0637,RC,00527-1324-01,NDC,facility,inpatient,1,EA,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
digoxin 125 mcg (0.125 mg) Tab,74473,CDM,,,0637,RC,59651-0437-01,NDC,facility,inpatient,1,EA,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
digoxin 250 mcg (0.25 mg) Tab,74474,CDM,,,0637,RC,00143-1241-01,NDC,facility,inpatient,1,EA,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
digoxin 250 mcg (0.25 mg) Tab [MDH],74474,CDM,,,0637,RC,00527-1325-01,NDC,facility,inpatient,1,EA,,7.17,4.3,5.88,7.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.88,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
zolpidem 2.5 mg tab (1/2) [MDH],71893,CDM,,,0637,RC,51079-0724-01A,NDC,facility,inpatient,1,EA,,7.19,4.31,5.9,7.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
orphenadrine 100 mg ER Tab [MDH],75720,CDM,,,0637,RC,43386-0480-24,NDC,facility,inpatient,1,EA,,7.19,4.31,5.9,7.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gemfibrozil 600 mg Tab,70062,CDM,,,0637,RC,60687-0224-01,NDC,facility,inpatient,1,EA,,7.21,4.33,5.91,7.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ursodiol 300 mg Cap [MDH],77044,CDM,,,0637,RC,68084-0213-01,NDC,facility,inpatient,1,EA,,7.21,4.33,5.91,7.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.13,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium sulfate 50% Sol,78701,CDM,,,0636,RC,63323-0064-03,NDC,facility,inpatient,2,ML,,7.27,4.36,5.96,7.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.91,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",5.96,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.18,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
doxycycline monohydrate 100 mg Cap [MDH],78520,CDM,,,0637,RC,49884-0727-03,NDC,facility,inpatient,1,EA,,7.34,4.4,6.02,7.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
doxycycline monohydrate 100 mg Cap,78520,CDM,,,0637,RC,68382-0707-18,NDC,facility,inpatient,1,EA,,7.34,4.4,6.02,7.34,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.34,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.97,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.02,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 30 mg/mL Sol,70224,CDM,,,0636,RC,00338-0072-25,NDC,facility,inpatient,1,ML,,7.35,4.41,6.03,7.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 30 mg/mL Sol,70224,CDM,,,0636,RC,72266-0118-25,NDC,facility,inpatient,1,ML,,7.35,4.41,6.03,7.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.62,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.03,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.25,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.62,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 80 mg Cap,73968,CDM,,,0637,RC,43478-0901-88,NDC,facility,inpatient,1,EA,,7.37,4.42,6.04,7.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxazepam 10 mg Cap [MDH],76990,CDM,,,0637,RC,62584-0812-01,NDC,facility,inpatient,1,EA,,7.37,4.42,6.04,7.37,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.37,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.04,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.26,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab [MDH],76118,CDM,,,0637,RC,68001-0240-00,NDC,facility,inpatient,1,EA,,7.46,4.48,6.12,7.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
famotidine 20 mg Tab,76118,CDM,,,0637,RC,68001-0397-00,NDC,facility,inpatient,1,EA,,7.46,4.48,6.12,7.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.34,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.71,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
methylphenidate 20 mg ER Tab [MDH],70337,CDM,,,0637,RC,00078-0442-05,NDC,facility,inpatient,1,EA,,7.47,4.48,6.13,7.47,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.47,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.72,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.1,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.72,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gemfibrozil 600 mg Tab [MDH],70062,CDM,,,0637,RC,31722-0225-60,NDC,facility,inpatient,1,EA,,7.48,4.49,6.13,7.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
gemfibrozil 600 mg Tab,70062,CDM,,,0637,RC,69097-0821-03,NDC,facility,inpatient,1,EA,,7.48,4.49,6.13,7.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
citalopram 10 mg Tab [MDH],71421,CDM,,,0637,RC,00904-6084-61,NDC,facility,inpatient,1,EA,,7.48,4.49,6.13,7.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cyanocobalamin 1000 mcg/mL Sol,72180,CDM,,,0636,RC,71288-0303-02,NDC,facility,inpatient,1,ML,,7.48,4.49,6.13,7.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.11,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.36,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.73,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
theophylline 200 mg/24 hours ERCap [MDH],77821,CDM,,,0637,RC,50474-0200-01,NDC,facility,inpatient,1,EA,,7.5,4.5,6.15,7.5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.5,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.12,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.15,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 250 mg Tab,70096,CDM,,,0637,RC,68084-0310-01,NDC,facility,inpatient,1,EA,,7.52,4.51,6.17,7.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.77,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.14,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.77,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
morphine 30 mg ER Tab [MDH],46531,CDM,,,0637,RC,66479-0541-25,NDC,facility,inpatient,1,EA,,7.54,4.52,6.18,7.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 250 mg ER Tab/24HR [MDH],70096,CDM,,,0637,RC,51079-0766-08,NDC,facility,inpatient,1,EA,,7.54,4.52,6.18,7.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.16,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.41,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.79,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
terbutaline 1 mg/mL Sol,71330,CDM,,,0636,RC,70860-0801-01,NDC,facility,inpatient,1,ML,,7.56,4.54,6.2,7.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 1 mg/mL Inj Sol 5 mL [MDH],74693,CDM,,,0636,RC,70860-0300-05,NDC,facility,inpatient,5,ML,,7.56,4.54,6.2,7.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
silver nitrate Top Stick [MDH],77047,CDM,,,0637,RC,12870-0001-01,NDC,facility,inpatient,1,EA,,7.56,4.54,6.2,7.56,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.56,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.2,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ibuprofen 100 mg/5 mL Sus,71648,CDM,,,0637,RC,68094-0600-61,NDC,facility,inpatient,5,ML,,7.58,4.55,6.22,7.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
baclofen 10 mg Tab [MDH],74645,CDM,,,0637,RC,00832-1024-00,NDC,facility,inpatient,1,EA,,7.58,4.55,6.22,7.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
baclofen 10 mg Tab,74645,CDM,,,0637,RC,00832-1054-11,NDC,facility,inpatient,1,EA,,7.58,4.55,6.22,7.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
baclofen 10 mg Tab,74645,CDM,,,0637,RC,52817-0320-10,NDC,facility,inpatient,1,EA,,7.58,4.55,6.22,7.58,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.58,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.2,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 1 mg Tab [MDH],70072,CDM,,,0637,RC,00056-0169-75,NDC,facility,inpatient,1,EA,,7.59,4.55,6.22,7.59,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.59,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.83,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.21,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.45,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.83,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 120 mg Sup,78303,CDM,,,0637,RC,51672-2115-02,NDC,facility,inpatient,1,EA,,7.6,4.56,6.23,7.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.6,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.84,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.46,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.84,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
rOPINIRole 0.25 mg Tab [MDH],71432,CDM,,,0637,RC,68462-0253-01,NDC,facility,inpatient,1,EA,,7.61,4.57,6.24,7.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FLUoxetine 20 mg Cap [MDH],76712,CDM,,,0637,RC,00904-5785-61,NDC,facility,inpatient,1,EA,,7.61,4.57,6.24,7.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
benzonatate 100 mg Cap [MDH],77765,CDM,,,0637,RC,67877-0105-01,NDC,facility,inpatient,1,EA,,7.61,4.57,6.24,7.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
benzonatate 100 mg Cap [MDH],77765,CDM,,,0637,RC,67877-0573-01,NDC,facility,inpatient,1,EA,,7.61,4.57,6.24,7.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
benzonatate 100 mg Cap [MDH],77765,CDM,,,0637,RC,69387-0119-01,NDC,facility,inpatient,1,EA,,7.61,4.57,6.24,7.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
rOPINIRole 1 mg Tab [MDH],78008,CDM,,,0637,RC,68462-0255-01,NDC,facility,inpatient,1,EA,,7.61,4.57,6.24,7.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.85,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.23,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.24,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.47,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.85,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ezetimibe 10 mg Tab [MDH],70123,CDM,,,0637,RC,49884-0228-11,NDC,facility,inpatient,1,EA,,7.62,4.57,6.25,7.62,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.62,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.24,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.25,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 500 mg/100 mL Sol,73357,CDM,,,0636,RC,00409-7811-10,NDC,facility,inpatient,100,ML,,7.64,4.58,6.26,7.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lactulose 10 g/15 mL Syr,75583,CDM,,,0637,RC,00121-1154-40,NDC,facility,inpatient,30,ML,,7.64,4.58,6.26,7.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FLUoxetine 20 mg Cap [MDH],76712,CDM,,,0637,RC,68084-0605-01,NDC,facility,inpatient,1,EA,,7.64,4.58,6.26,7.64,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.64,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.26,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
rOPINIRole 0.25 mg Tab,71432,CDM,,,0637,RC,62332-0030-31,NDC,facility,inpatient,1,EA,,7.65,4.59,6.27,7.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
rOPINIRole 1 mg Tab,78008,CDM,,,0637,RC,62332-0032-31,NDC,facility,inpatient,1,EA,,7.65,4.59,6.27,7.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.27,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 10 mg/mL Inj Sol 4mL [MDH],74556,CDM,,,0636,RC,00517-5704-25,NDC,facility,inpatient,4,ML,,7.66,4.6,6.28,7.66,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.66,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.28,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.28,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.51,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.89,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
verapamil 240 mg ER Tab [MDH],71439,CDM,,,0637,RC,51079-0869-20,NDC,facility,inpatient,1,EA,,7.68,4.61,6.3,7.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
lactulose 10 g/15 mL Oral Syrup [MDH],75583,CDM,,,0637,RC,00121-4577-30,NDC,facility,inpatient,30,ML,,7.68,4.61,6.3,7.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.91,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.3,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.53,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.91,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
mexiletine 150 mg Cap [MDH],72040,CDM,,,0637,RC,00093-8739-01,NDC,facility,inpatient,1,EA,,7.69,4.61,6.31,7.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
chlorproPAMIDE 250 mg Tab [MDH],72540,CDM,,,0637,RC,00378-0210-01,NDC,facility,inpatient,1,EA,,7.7,4.62,6.31,7.7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.7,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.31,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
nizatidine 150 mg Cap [MDH],71699,CDM,,,0637,RC,00247-0498-30,NDC,facility,inpatient,1,EA,,7.71,4.63,6.32,7.71,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.71,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.32,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.32,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.55,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
topiramate 25 mg Tab,78016,CDM,,,0637,RC,68382-0138-14,NDC,facility,inpatient,1,EA,,7.73,4.64,6.34,7.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.96,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.34,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.57,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.96,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sotalol 80 mg Tab [MDH],70389,CDM,,,0637,RC,00603-5769-21,NDC,facility,inpatient,1,EA,,7.75,4.65,6.36,7.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sotalol 80 mg Tab [MDH],70389,CDM,,,0637,RC,60505-0080-00,NDC,facility,inpatient,1,EA,,7.75,4.65,6.36,7.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.59,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
promethazine 25 mg/mL Sol,76245,CDM,,,0636,RC,00641-0928-25,NDC,facility,inpatient,1,ML,,7.76,4.66,6.36,7.76,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.76,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propranolol 80 mg ERCap [MDH],73968,CDM,,,0637,RC,68084-0504-01,NDC,facility,inpatient,1,EA,,7.77,4.66,6.37,7.77,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.77,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,6.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.99,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.37,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.6,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.99,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pancrelipase 6000 units-19000 units-30000 units Cap,72054,CDM,,,0636,RC,00032-0046-70,NDC,facility,inpatient,1,EA,,7.78,4.67,6.38,7.78,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.78,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.39,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 2 mg Tab [MDH],72130,CDM,,,0637,RC,00056-0170-75,NDC,facility,inpatient,1,EA,,7.8,4.68,6.4,7.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.02,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.41,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.63,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.02,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
mineral oil 100% Oral Liq UD [MDH],71965,CDM,,,0637,RC,48433-0202-30,NDC,facility,inpatient,30,ML,,7.85,4.71,6.44,7.85,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.85,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.46,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.67,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OXcarbazepine 300 mg Tab,71824,CDM,,,0637,RC,68462-0138-01,NDC,facility,inpatient,1,EA,,7.86,4.72,6.45,7.86,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.86,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.47,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PARoxetine 10 mg Tab [MDH],72087,CDM,,,0636,RC,68382-0097-06,NDC,facility,inpatient,1,EA,,7.88,4.73,6.46,7.88,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.88,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.09,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.49,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.7,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.09,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxazepam 15 mg Cap [MDH],76995,CDM,,,0637,RC,62584-0813-01,NDC,facility,inpatient,1,EA,,7.9,4.74,6.48,7.9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.11,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.11,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
promethazine 25 mg/mL Sol,76245,CDM,,,0636,RC,00641-1495-35,NDC,facility,inpatient,1,ML,,7.91,4.75,6.49,7.91,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.91,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.12,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.51,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.12,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
mirtazapine 7.5 mg Tab,72265,CDM,,,0637,RC,13107-0001-30,NDC,facility,inpatient,1,EA,,7.92,4.75,6.49,7.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
mirtazapine 7.5 mg Tab [MDH],72265,CDM,,,0637,RC,66993-0606-30,NDC,facility,inpatient,1,EA,,7.92,4.75,6.49,7.92,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.92,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.49,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.73,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
morphine 4 mg/mL preservative-free Sol 1 mL[MDH],71673,CDM,,,0636,RC,00409-1891-01,NDC,facility,inpatient,1,ML,,7.93,4.76,6.5,7.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
morphine 10 mg/mL preservative-free Sol 1 mL [MDH],71675,CDM,,,0636,RC,00409-1893-01,NDC,facility,inpatient,1,ML,,7.93,4.76,6.5,7.93,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.93,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.53,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.5,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.14,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 30 mg/mL Sol,70224,CDM,,,0636,RC,62332-0600-25,NDC,facility,inpatient,1,ML,,7.98,4.79,6.54,7.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 500 mg/100 mL IV Sol [MDH],73357,CDM,,,0636,RC,00409-7811-24,NDC,facility,inpatient,100,ML,,7.98,4.79,6.54,7.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dilTIAZem 300 mg/24 hours Cap,75206,CDM,,,0637,RC,50742-0251-90,NDC,facility,inpatient,1,EA,,7.98,4.79,6.54,7.98,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.98,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.78,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.18,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
LORazepam 2 mg/mL Inj Sol 1 mL [MDH],70813,CDM,,,0636,RC,00641-6001-25,NDC,facility,inpatient,1,ML,,7.99,4.79,6.55,7.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 2.5 mg Tab [MDH],72131,CDM,,,0637,RC,00056-0176-75,NDC,facility,inpatient,1,EA,,7.99,4.79,6.55,7.99,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.99,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.59,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bumetanide 1 mg Tab,71379,CDM,,,0637,RC,42799-0120-01,NDC,facility,inpatient,1,EA,,8.01,4.81,6.57,8.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pindolol 10 mg Tab [MDH],72193,CDM,,,0637,RC,76385-0132-01,NDC,facility,inpatient,1,EA,,8.01,4.81,6.57,8.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bethanechol 25 mg Tab,78345,CDM,,,0637,RC,00832-0512-00,NDC,facility,inpatient,1,EA,,8.01,4.81,6.57,8.01,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.01,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.61,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.57,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.81,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 3 mg Tab [MDH],70171,CDM,,,0250,RC,00056-0188-75,NDC,facility,inpatient,1,EA,,8.02,4.81,6.58,8.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
citalopram 40 mg Tab [MDH],71137,CDM,,,0637,RC,65162-0054-10,NDC,facility,inpatient,1,EA,,8.02,4.81,6.58,8.02,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.02,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.22,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 300 mg/24 hours ERCap [MDH],75206,CDM,,,0637,RC,68084-0055-01,NDC,facility,inpatient,1,EA,,8.03,4.82,6.58,8.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.23,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.23,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
dilTIAZem 300 mg/24 hours Cap,75206,CDM,,,0637,RC,10370-0832-11,NDC,facility,inpatient,1,EA,,8.05,4.83,6.6,8.05,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.05,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.65,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.84,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
bumetanide 1 mg Tab,71379,CDM,,,0637,RC,69238-1490-01,NDC,facility,inpatient,1,EA,,8.07,4.84,6.62,8.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.67,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.86,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
mirtazapine 15 mg Tab,71839,CDM,,,0637,RC,13107-0031-34,NDC,facility,inpatient,1,EA,,8.08,4.85,6.63,8.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ethinyl estradiol-norgestimate 35 mcg-0.25 mg Tab [MDH],72227,CDM,,,0637,RC,00555-9016-58,NDC,facility,inpatient,1,EA,,8.08,4.85,6.63,8.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenazopyridine 100 mg Tab [MDH],76735,CDM,,,0637,RC,51293-0611-01,NDC,facility,inpatient,1,EA,,8.08,4.85,6.63,8.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenazopyridine 100 mg Tab [MDH],76735,CDM,,,0637,RC,51293-0810-01,NDC,facility,inpatient,1,EA,,8.08,4.85,6.63,8.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenazopyridine 100 mg Tab,76735,CDM,,,0637,RC,65162-0681-10,NDC,facility,inpatient,1,EA,,8.08,4.85,6.63,8.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.68,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.63,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.87,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.27,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FLUoxetine 10 mg Tab [MDH],79065,CDM,,,0637,RC,49884-0734-11,NDC,facility,inpatient,1,EA,,8.15,4.89,6.68,8.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.15,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.68,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.93,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin/butalbital/caffeine/codeine 325 mg-50 mg-40 mg-30 mg Cap [MDH],46370,CDM,,,0637,RC,00591-3546-01,NDC,facility,inpatient,1,EA,,8.18,4.91,6.71,8.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
triazolam 0.125 mg Tab [MDH],73706,CDM,,,0637,RC,00054-8858-25,NDC,facility,inpatient,1,EA,,8.18,4.91,6.71,8.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.77,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.71,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
salsalate 750 mg Tab,72761,CDM,,,0637,RC,51293-0804-01,NDC,facility,inpatient,1,EA,,8.19,4.91,6.72,8.19,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.19,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.37,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.72,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.96,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.37,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
OXcarbazepine 300 mg Tab,71824,CDM,,,0637,RC,60687-0722-01,NDC,facility,inpatient,1,EA,,8.21,4.93,6.73,8.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxcarbazepine 300 mg Tab [MDH],71824,CDM,,,0637,RC,68084-0853-01,NDC,facility,inpatient,1,EA,,8.21,4.93,6.73,8.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.8,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.73,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.98,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaZOLAMIDE 250 mg Tab,72565,CDM,,,0637,RC,70756-0721-11,NDC,facility,inpatient,1,EA,,8.22,4.93,6.74,8.22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.22,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.4,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.74,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,6.99,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.4,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
warfarin 5 mg Tab [MDH],72135,CDM,,,0637,RC,00056-0172-75,NDC,facility,inpatient,1,EA,,8.26,4.96,6.77,8.26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.26,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.43,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.02,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.43,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
citalopram 40 mg Tab,71137,CDM,,,0637,RC,13668-0011-01,NDC,facility,inpatient,1,EA,,8.27,4.96,6.78,8.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.44,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.86,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.03,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.44,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
polyethylene glycol 3350 - Pow,72909,CDM,,,0636,RC,60687-0431-98,NDC,facility,inpatient,1,EA,,8.28,4.97,6.79,8.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
polyethylene glycol 3350 Oral Pwdr for Recon [MDH],72909,CDM,,,0637,RC,68084-0430-98,NDC,facility,inpatient,1,EA,,8.28,4.97,6.79,8.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.45,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.87,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.79,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.04,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.45,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PARoxetine 20 mg Tab [MDH],79957,CDM,,,0250,RC,68084-0045-01,NDC,facility,inpatient,1,EA,,8.29,4.97,6.8,8.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.8,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.05,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.46,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
salsalate 750 mg Tab [MDH],72761,CDM,,,0637,RC,42937-0704-10,NDC,facility,inpatient,1,EA,,8.32,4.99,6.82,8.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
salsalate 750 mg Tab,72761,CDM,,,0637,RC,65162-0513-10,NDC,facility,inpatient,1,EA,,8.32,4.99,6.82,8.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tobramycin 40 mg/mL Inj Sol 2mL [MDH],75445,CDM,,,0636,RC,67457-0432-02,NDC,facility,inpatient,2,ML,,8.32,4.99,6.82,8.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tobramycin 40 mg/mL Inj Sol 2mL [MDH],75445,CDM,,,0636,RC,67457-0473-22,NDC,facility,inpatient,2,ML,,8.32,4.99,6.82,8.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.9,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.49,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
amiodarone 50 mg/mL Sol,70238,CDM,,,0636,RC,00143-9875-25,NDC,facility,inpatient,3,ML,,8.4,5.04,6.89,8.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
heparin 5000 units/mL Sol,73754,CDM,,,0636,RC,63323-0262-26,NDC,facility,inpatient,1,ML,,8.4,5.04,6.89,8.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
furosemide 10 mg/mL Sol,74513,CDM,,,0636,RC,71288-0203-11,NDC,facility,inpatient,10,ML,,8.4,5.04,6.89,8.4,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.4,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.98,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.89,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.14,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.56,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ceFAZolin 500 mg Inj [MDH],71551,CDM,,,0636,RC,00143-9923-90,NDC,facility,inpatient,1,EA,,8.41,5.05,6.9,8.41,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.41,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7.99,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.9,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.15,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
sertraline 25 mg Tab [MDH],71414,CDM,,,0637,RC,51079-0149-20,NDC,facility,inpatient,1,EA,,8.43,5.06,6.91,8.43,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.43,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.91,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fentaNYL 0.05 mg/mL Inj Sol 2mL [MDH],46765,CDM,,,0636,RC,63323-0806-02,NDC,facility,inpatient,2,ML,,8.44,5.06,6.92,8.44,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.44,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.6,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.92,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.17,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
disopyramide 100 mg Cap [MDH],75745,CDM,,,0637,RC,00093-3127-01,NDC,facility,inpatient,1,EA,,8.46,5.08,6.94,8.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
disopyramide 100 mg Cap [MDH],75745,CDM,,,0637,RC,00591-5560-01,NDC,facility,inpatient,1,EA,,8.46,5.08,6.94,8.46,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.46,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.94,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.19,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.61,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FLUoxetine 10 mg Tab [MDH],79065,CDM,,,0637,RC,00378-0734-01,NDC,facility,inpatient,1,EA,,8.48,5.09,6.95,8.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FLUoxetine 10 mg Tab,79065,CDM,,,0637,RC,49884-0335-11,NDC,facility,inpatient,1,EA,,8.48,5.09,6.95,8.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
FLUoxetine 10 mg Tab,79065,CDM,,,0637,RC,59651-0308-01,NDC,facility,inpatient,1,EA,,8.48,5.09,6.95,8.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.63,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.95,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.21,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.63,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaZOLAMIDE 250 mg Tab [MDH],72565,CDM,,,0637,RC,51672-4023-01,NDC,facility,inpatient,1,EA,,8.52,5.11,6.99,8.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.67,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.09,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",6.99,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.24,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.67,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
magnesium citrate 1.745 gm/30 mL Oral Liq 300 mL [MDH],71770,CDM,,,0637,RC,00869-0686-38,NDC,facility,inpatient,300,ML,,8.61,5.17,7.06,8.61,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.61,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.75,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.18,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.06,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.32,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.75,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
PARoxetine 20 mg Tab [MDH],79957,CDM,,,0637,RC,00904-5677-61,NDC,facility,inpatient,1,EA,,8.65,5.19,7.09,8.65,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.65,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.78,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.22,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.09,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.35,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.78,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
phenytoin 100 mg/4 mL Oral Susp [MDH],70068,CDM,,,0637,RC,68094-0533-58,NDC,facility,inpatient,4,ML,,8.68,5.21,7.12,8.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pramipexole 0.125 mg Tab [MDH],70390,CDM,,,0637,RC,13668-0091-90,NDC,facility,inpatient,1,EA,,8.68,5.21,7.12,8.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pramipexole 0.5 mg Tab [MDH],71063,CDM,,,0637,RC,13668-0093-90,NDC,facility,inpatient,1,EA,,8.68,5.21,7.12,8.68,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.68,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.25,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.12,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.38,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.81,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 1 mg/mL Inj Sol 10mL [MDH],70268,CDM,,,0636,RC,00409-2587-53,NDC,facility,inpatient,10,ML,,8.69,5.21,7.13,8.69,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.69,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.26,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.13,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.39,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.82,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
pravastatin 20 mg Tab [MDH],71174,CDM,,,0250,RC,00904-5892-61,NDC,facility,inpatient,1,EA,,8.73,5.24,7.16,8.73,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.73,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.86,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.29,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.16,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.42,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.86,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
EPINEPHrine 1 mg/mL Inj Sol 1 mL [MDH],70215,CDM,,,0636,RC,00409-7241-25,NDC,facility,inpatient,1,ML,,8.74,5.24,7.17,8.74,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.74,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.87,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.3,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.17,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.43,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.87,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levoFLOXacin 500 mg/100 mL Sol,70187,CDM,,,0636,RC,00143-9316-24,NDC,facility,inpatient,100,ML,,8.75,5.25,7.18,8.75,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.75,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.88,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.31,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.18,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.44,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.88,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
propantheline 15 mg Tab [MDH],76600,CDM,,,0637,RC,00054-4721-25,NDC,facility,inpatient,1,EA,,8.8,5.28,7.22,8.8,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.8,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.92,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.36,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.48,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.92,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
medroxyPROGESTERone 2.5 mg Tab [MDH],77054,CDM,,,0637,RC,00009-0064-04,NDC,facility,inpatient,1,EA,,8.81,5.29,7.22,8.81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.81,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.93,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.37,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.22,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.49,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.93,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxybutynin 5 mg ER Tab [MDH],70121,CDM,,,0637,RC,68084-0480-01,NDC,facility,inpatient,1,EA,,8.82,5.29,7.23,8.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
EPINEPHrine 1 mg/mL Inj Sol 1 mL [MDH],70215,CDM,,,0636,RC,00409-7241-01,NDC,facility,inpatient,1,ML,,8.82,5.29,7.23,8.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
polyethylene glycol 3350 Oral Pwdr for Recon [MDH],72909,CDM,,,0636,RC,00574-0412-07,NDC,facility,inpatient,1,EA,,8.82,5.29,7.23,8.82,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.82,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.94,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.38,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.23,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.5,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.94,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metroNIDAZOLE 500 mg/100 mL Sol,73357,CDM,,,0636,RC,00409-0152-24,NDC,facility,inpatient,100,ML,,8.87,5.32,7.27,8.87,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.87,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,7.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.98,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.43,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.27,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.54,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.98,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
liothyronine 25 mcg Tab [MDH],72200,CDM,,,0637,RC,60793-0116-01,NDC,facility,inpatient,1,EA,,8.89,5.33,7.29,8.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
labetalol 5 mg/mL Sol,77027,CDM,,,0636,RC,36000-0322-02,NDC,facility,inpatient,20,ML,,8.89,5.33,7.29,8.89,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.89,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.45,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.29,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.56,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 5 mg/mL IV Sol 5 mL[MDH],75249,CDM,,,0636,RC,00409-1171-01,NDC,facility,inpatient,5,ML,,8.95,5.37,7.34,8.95,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.95,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.06,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.5,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.34,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.61,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.06,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxybutynin 5 mg/24 hours Tab,70121,CDM,,,0637,RC,62175-0270-37,NDC,facility,inpatient,1,EA,,8.97,5.38,7.36,8.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
irbesartan 150 mg Tab [MDH],70363,CDM,,,0637,RC,68180-0411-09,NDC,facility,inpatient,1,EA,,8.97,5.38,7.36,8.97,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.97,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.07,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.52,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.36,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.62,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.07,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
90686 Influenza virus vaccine quadrivalent split virus preservative free3+ years [MCDO],90686,CDM,90686,CPT,0636,RC,,,facility,inpatient,,,,9,5.4,7.38,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
MDH ANES MINUTES 60+,ANES5,CDM,,,0963,RC,,,professional,inpatient,,,,9,5.4,7.38,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
MDH CRNA MINUTES 60+,CRNA5,CDM,,,0964,RC,,,professional,inpatient,,,,9,5.4,7.38,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.1,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.55,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.38,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.65,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.1,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meloxicam 7.5 mg Tab,81971,CDM,,,0637,RC,50268-0525-15,NDC,facility,inpatient,1,EA,,9.03,5.42,7.4,9.03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.03,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.13,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.58,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.4,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.68,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.13,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
finasteride 5 mg Tab,79034,CDM,,,0637,RC,31722-0525-90,NDC,facility,inpatient,1,EA,,9.07,5.44,7.44,9.07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.07,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.16,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.62,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.44,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.71,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.16,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
DOPamine 40 mg/mL IV Sol [MDH],72853,CDM,,,0636,RC,00409-9104-20,NDC,facility,inpatient,10,ML,,9.08,5.45,7.45,9.08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.08,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.17,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.63,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.45,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.72,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.17,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metoprolol 1 mg/mL Inj Sol 5 mL [MDH],74693,CDM,,,0636,RC,00409-2285-05,NDC,facility,inpatient,5,ML,,9.1,5.46,7.46,9.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
finasteride 5 mg Tab,79034,CDM,,,0637,RC,16729-0090-01,NDC,facility,inpatient,1,EA,,9.1,5.46,7.46,9.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
finasteride 5 mg Tab [MDH],79034,CDM,,,0637,RC,51079-0520-20,NDC,facility,inpatient,1,EA,,9.1,5.46,7.46,9.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
finasteride 5 mg Tab,79034,CDM,,,0637,RC,65862-0149-30,NDC,facility,inpatient,1,EA,,9.1,5.46,7.46,9.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
finasteride 5 mg Tab [MDH],79034,CDM,,,0637,RC,65862-0149-90,NDC,facility,inpatient,1,EA,,9.1,5.46,7.46,9.1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.1,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.19,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.64,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.46,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.74,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.19,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meloxicam 7.5 mg Tab [MDH],81971,CDM,,,0637,RC,51079-0457-20,NDC,facility,inpatient,1,EA,,9.12,5.47,7.48,9.12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.12,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.21,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.66,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.48,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.75,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.21,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
fentaNYL 0.05 mg/mL Inj Sol 2mL [MDH],46765,CDM,,,0636,RC,00641-6027-25,NDC,facility,inpatient,2,ML,,9.16,5.5,7.51,9.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 5 mg/mL IV Sol 5 mL[MDH],75249,CDM,,,0636,RC,00641-9217-10,NDC,facility,inpatient,5,ML,,9.16,5.5,7.51,9.16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.16,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.24,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.7,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.51,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.24,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
acetaminophen 325 mg/10.15 mL Liq,70342,CDM,,,0637,RC,00904-7320-71,NDC,facility,inpatient,10.15,ML,,9.17,5.5,7.52,9.17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.17,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.25,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.71,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.52,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.79,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.25,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketoconazole 200 mg Tab [MDH],75693,CDM,,,0637,RC,51672-4026-06,NDC,facility,inpatient,1,EA,,9.18,5.51,7.53,9.18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.18,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.26,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.72,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.53,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.8,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.26,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
meloxicam 7.5 mg Tab,81971,CDM,,,0250,RC,68382-0050-01,NDC,facility,inpatient,1,EA,,9.2,5.52,7.54,9.2,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.2,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.28,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.74,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.54,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.82,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.28,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
diltiazem 60 mg ERCap [MDH],72554,CDM,,,0637,RC,00378-6060-01,NDC,facility,inpatient,1,EA,,9.21,5.53,7.55,9.21,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.21,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.29,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.75,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.55,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.83,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.29,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 1 mg/mL Inj Sol 10mL [MDH],70268,CDM,,,0636,RC,00641-6056-10,NDC,facility,inpatient,10,ML,,9.24,5.54,7.58,9.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
cefotaxime 1 g Pow,71772,CDM,,,0636,RC,00143-9931-25,NDC,facility,inpatient,1,EA,,9.24,5.54,7.58,9.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
mannitol 25% IV Sol 50 mL [MDH],74845,CDM,,,0636,RC,00409-4031-01,NDC,facility,inpatient,50,ML,,9.24,5.54,7.58,9.24,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.24,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.32,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.78,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.58,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.85,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.32,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
iodine-potassium iodide 5%-10% Sol [MDH],72111,CDM,,,0637,RC,10481-0111-08,NDC,facility,inpatient,8,ML,,9.27,5.56,7.6,9.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
docusate 10 mg/mL Liq,75591,CDM,,,0637,RC,00904-7279-72,NDC,facility,inpatient,10,ML,,9.27,5.56,7.6,9.27,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.27,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.34,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.81,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.6,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.88,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.34,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ketorolac 30 mg/mL Inj Sol  1 mL [MDH],70224,CDM,,,0636,RC,00409-3795-49,NDC,facility,inpatient,1,ML,,9.28,5.57,7.61,9.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
levoFLOXacin 750 mg/150 mL Sol,71353,CDM,,,0636,RC,00143-9317-24,NDC,facility,inpatient,150,ML,,9.28,5.57,7.61,9.28,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.28,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.35,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.82,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.61,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.89,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.35,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
aspirin 300 mg Supp [MDH],70780,CDM,,,0637,RC,00574-7034-12,NDC,facility,inpatient,1,EA,,9.29,5.57,7.62,9.29,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.29,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.36,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.83,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.62,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.9,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.36,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
clotrimazole 10 mg Loz,75238,CDM,,,0637,RC,00054-4146-22,NDC,facility,inpatient,1,EA,,9.32,5.59,7.64,9.32,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.32,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.39,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.85,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.64,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.92,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.39,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
divalproex sodium 500 mg Tab,71826,CDM,,,0636,RC,68084-0782-61,NDC,facility,inpatient,1,EA,,9.35,5.61,7.67,9.35,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.35,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.41,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,8.88,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.67,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,7.95,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.41,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metolazone 2.5 mg Tab [MDH],72770,CDM,,,0637,RC,51079-0023-20,NDC,facility,inpatient,1,EA,,9.48,5.69,7.77,9.48,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.48,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.53,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.01,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.77,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.06,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.53,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
oxyBUTYnin 5 mg/24 hr Tab,70121,CDM,,,0637,RC,27241-0155-04,NDC,facility,inpatient,1,EA,,9.49,5.69,7.78,9.49,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.49,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.54,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.02,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.78,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.07,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.54,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
ramelteon 8 mg oral tablet [MDH],71744,CDM,,,0637,RC,16590-0517-21,NDC,facility,inpatient,1,EA,,9.52,5.71,7.81,9.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
metOLazone 2.5 mg Tab,72770,CDM,,,0637,RC,60687-0624-01,NDC,facility,inpatient,1,EA,,9.52,5.71,7.81,9.52,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.52,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.57,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.04,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.81,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.09,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.57,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tolterodine 1 mg Tab [MDH],70175,CDM,,,0637,RC,00093-2056-06,NDC,facility,inpatient,1,EA,,9.54,5.72,7.82,9.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tolterodine 1 mg Tab,70175,CDM,,,0637,RC,29300-0239-16,NDC,facility,inpatient,1,EA,,9.54,5.72,7.82,9.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
tolterodine 1 mg Tab,70175,CDM,,,0637,RC,59762-0170-06,NDC,facility,inpatient,1,EA,,9.54,5.72,7.82,9.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
morphine 4 mg/mL preservative-free Sol,71673,CDM,,,0636,RC,00641-6125-25,NDC,facility,inpatient,1,ML,,9.54,5.72,7.82,9.54,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.54,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.59,90,,,,,0,percent of total billed charges,"Rate only applies when calculated under All Other contract terms | No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.06,95,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",7.82,82,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.11,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,8.59,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",,,,,,,,,,,,,,,,,,
midazolam 1 mg/mL Sol,70268,CDM,,,0636,RC,00409-2587-05,NDC,facility,inpatient,10,ML,,9.55,5.73,7.83,9.55,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,9.55,100,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.12,85,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/plan, as remittances do not itemize at the CDM level.",8.6,90,,,,,0,percent of total billed charges,"No historical remittance data available for this CDM code type under the specified payer/pl